Valve Vera — Valvular Heart Disease & Rheumatic Fever
A childhood strep throat left scarred valves — now a harsh murmur and signs of failure decades later
Vera, now 45, recalls a bout of untreated strep throat and joint pain as a child, and today she presents with progressive dyspnea on exertion and a diastolic murmur best heard at the apex.
Vera had untreated strep throat as a child that triggered rheumatic fever, and the resulting autoimmune reaction scarred her mitral valve over decades. Stenotic valves obstruct forward flow and cause symptoms behind the blockage, while regurgitant valves let blood leak backward and cause volume overload. Recognizing the type and location of a murmur, along with the resulting heart failure symptoms, drives nursing priorities and patient teaching about future endocarditis prophylaxis.
Read Valve Vera's full story →The story arc
The setup
As a child, Vera had an untreated streptococcal throat infection followed by fever, migratory joint pain, and a rash — features of acute rheumatic fever.
The turn
Decades later Vera develops progressive fatigue and exertional dyspnea, and her provider hears a low-pitched diastolic rumble at the apex.
The crisis
Vera develops atrial fibrillation, worsening orthopnea, and crackles in both lung bases, with an echocardiogram confirming a critically narrowed mitral valve area.
The save
The nurse manages her heart failure symptoms, anticoagulates her for atrial fibrillation to prevent embolic stroke, and prepares her for possible balloon valvuloplasty or valve replacement.
NCLEX study section — Valvular Heart Disease & Rheumatic Fever
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.