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Valvular Heart Disease > Acute Rheumatic Fever > Flashcards

Acute Rheumatic Fever Flashcards

1
Q

What is rheumatic fever (RF)?

A

A noninfectious consequence of pharyngitis caused by group A β-hemolytic streptococci (GABHS).

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2
Q

What are the common presentations of acute rheumatic fever?

A
  • Arthritis
  • Carditis
  • Chorea
  • Erythema marginatum
  • Subcutaneous nodules
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3
Q

What is the major long-term consequence of acute rheumatic fever?

A

Valvular heart disease.

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4
Q

What is the estimated annual occurrence of acute rheumatic fever in the developing world?

A

Between 1 and 194 per 100,000 population.

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5
Q

Which populations have the highest rates of acute rheumatic fever?

A
  • Indigenous people in the Northern Territory of Australia
  • Countries in the South Pacific
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6
Q

What is the estimated global prevalence of rheumatic heart disease (RHD) as of 2015?

A

Over 34 million people, with over 29 million in developing countries.

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7
Q

What factors contributed to the decline of acute rheumatic fever in the United States since the 1960s?

A
  • Improved socioeconomic status
  • Less crowded housing conditions
  • Advent of antibiotics
  • Widespread treatment of streptococcal throat infections
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8
Q

What is a significant factor in the pathogenesis of acute rheumatic fever?

A

An autoimmune process.

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9
Q

What are the salient features of the pathogenesis of acute rheumatic fever?

A
  • Human host with RF susceptibility factors
  • Pharyngitis
  • Immune response against specific streptococcal antigens
  • Interval of 1–5 weeks between pharyngitis and ARF development
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10
Q

Which racial groups have an increased susceptibility to rheumatic fever?

A
  • Samoans in Hawaii
  • Maori in New Zealand
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11
Q

What are the serotypes of GABHS commonly associated with initiating ARF?

A
  • M-types 1, 3, 5, 6, 14, 18, 19, 24, 27, and 29
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12
Q

True or False: Skin infections with GABHS can lead to acute rheumatic fever.

A

False.

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13
Q

What is the primary mechanism of damage in acute rheumatic fever?

A

Autoimmune injury due to cross-reactive antibodies.

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14
Q

What are Aschoff bodies?

A

Granulomatous reactions formed in response to the damage of collagenous matrix in ARF.

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15
Q

What is the characteristic pathological finding in the myocardium associated with ARF?

A

Fibrinoid necrosis and granulomatous inflammation.

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16
Q

What type of pericarditis is typically associated with acute rheumatic fever?

A

Fibrinous pericarditis.

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17
Q

Fill in the blank: Acute rheumatic fever is a febrile multisystem disorder known as _______.

A

ARF.

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18
Q

What are the typical valve lesions associated with rheumatic heart disease?

A

Inflammation and thickening of the valves.

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19
Q

What is the role of T cells in the pathogenesis of ARF?

A

T cells become activated by streptococcal antigens and contribute to tissue damage.

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20
Q

What is the typical histopathologic damage to the myocardium in ARF?

A

Little histopathologic damage; myocyte necrosis is uncommon.

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21
Q

What is the common clinical manifestation of migratory polyarthritis in ARF?

A

Swelling with serous effusion in the joints.

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22
Q

What is the primary focus of ARF-induced damage?

A

Endothelium and subendothelial and perivascular connective tissue.

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23
Q

What is the significance of the M-protein in the pathogenesis of ARF?

A

It can trigger cross-reactive antibodies and T-cell responses.

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24
Q

What are verrucae in the context of rheumatic heart disease?

A

Minute, translucent nodular vegetations located along the lines of closure on the inflow (atrial) side of the leaflets

They represent foci of fibrinoid necrosis and thrombosis devoid of micro-organisms.

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25
Q

What is Libman-Sacks endocarditis (LSE)?

A

A type of sterile vegetative endocarditis caused by systemic lupus erythematosus (SLE), characterized by small or medium-sized vegetations on either or both sides of the valve leaflets.

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26
Q

How does rheumatic vegetative endocarditis differ from non-bacterial thrombotic endocarditis (NBTE) and infective endocarditis (IE)?

A

Both types of rheumatic vegetative endocarditis are distinct in their patterns compared to NBTE and IE.

27
Q

What occurs to the valve tissue during the repair process after rheumatic fever?

A

Involves ingrowth of blood vessels (neovascularization) and deposition of collagen.

28
Q

What is the earliest manifestation of acute rheumatic fever (ARF)?

A

Arthritis.

29
Q

Which joints are commonly involved in arthritis associated with rheumatic fever?

A

Larger joints of the extremities, with occasional involvement of smaller joints in the hands and feet.

30
Q

What are Aschoff bodies?

A

Granulomatous lesions that result from autoimmune injury in rheumatic fever.

31
Q

What are the long-term effects of acute rheumatic fever on the heart?

A

Can lead to chronic rheumatic heart disease, characterized by stenosis and regurgitation of the mitral and/or aortic valves.

32
Q

What characterizes Sydenham chorea?

A

A late manifestation of ARF with involuntary movements involving the face and extremities, often associated with emotional lability.

33
Q

What is the role of echocardiography in diagnosing rheumatic carditis?

A

It can document valvular regurgitation and detect subclinical carditis.

34
Q

What are the major criteria for diagnosing acute rheumatic fever according to Jones criteria?

A
  • Carditis
  • Chorea
  • Subcutaneous nodules
  • Migratory arthritis involving large joints
  • Erythema marginatum.
35
Q

What are the minor criteria for diagnosing acute rheumatic fever?

A
  • Arthralgia
  • Fever
  • Prolonged PR interval
  • Elevated inflammatory markers.
36
Q

True or False: Carditis is the only manifestation of rheumatic fever that leads to permanent deformity.

A

True.

37
Q

What is a characteristic feature of the inflammation seen in rheumatic heart disease?

A

The presence of neovascularization and thick-walled blood vessels in the valve leaflets.

38
Q

What is the typical duration for arthritis in rheumatic fever?

A

Usually resolves in 3-4 weeks, even without treatment.

39
Q

What is the significance of an elevated antistreptolysin O (ASO) titer in diagnosing rheumatic fever?

A

It indicates previous streptococcal infection and is a prerequisite for diagnosis.

40
Q

What is the recommended change in the Jones criteria regarding subclinical carditis?

A

It should be considered a major criterion.

41
Q

What is a common histological finding in myocarditis associated with rheumatic fever?

A

Minimal myocyte damage.

42
Q

What is the typical presentation of rheumatic pericarditis?

A

Evanescent pericardial friction rub, often associated with severe carditis.

43
Q

What can mask the underlying valvular murmurs in rheumatic pericarditis?

A

A pericardial rub.

44
Q

What is the clinical significance of post-streptococcal arthropathy?

A

Characterized by recurrent, severe, prolonged polyarthritis that is not very responsive to nonsteroidal anti-inflammatory agents.

45
Q

What types of valve diseases are most commonly seen in rheumatic fever?

A
  • Mitral valve disease (70% of cases)
  • Aortic valve disease (5-8% of cases).
46
Q

Fill in the blank: The inflammatory changes in the aortic valves can result in _______.

A

aortic regurgitation.

47
Q

What is the relationship between chronic rheumatic heart disease and systemic lupus erythematosus?

A

They share similar pathologic features.

48
Q

What is the migratory character of joint pain in rheumatic fever?

A

Joints are inflamed at different times and for various intervals.

49
Q

What is the typical appearance of erythema marginatum?

A

Serpiginous, macular, non-pruritic, and evanescent rash on the trunk and proximal extremities.

50
Q

What viral syndromes are associated with carditis?

A

Coxsackie B virus, Lyme disease, Kawasaki infection

These conditions can lead to inflammatory abnormalities of the heart valves.

51
Q

Which collagen diseases may confuse the diagnosis of carditis?

A

Systemic lupus erythematosus, rheumatoid arthritis

These diseases can present early manifestations that mimic carditis.

52
Q

What is the prerequisite for the diagnosis of rheumatic fever (RF)?

A

Evidence of previous streptococcal infection

RF is a postinfectious immunologic complication.

53
Q

What are the commonly used antibody tests for streptococcal infection?

A
  • ASO (Antistreptolysin O)
  • Anti-DNase B
  • Hyaluronidase
  • Streptokinase
  • Nicotinamide adenine dinucleotide (NAD)

These tests help assess recent streptococcal infections.

54
Q

What ASO level is generally used for diagnosis in adults?

A

More than 240 U

For children, the threshold is more than 330 U.

55
Q

What can ST-segment changes in an electrocardiogram indicate in patients with RF?

A

Pericarditis

Repolarization abnormalities may indicate myocarditis.

56
Q

What is the role of echocardiography in diagnosing RF?

A

Diagnosing and monitoring cardiac structure and function

It helps identify valve regurgitation and assess cardiac damage.

57
Q

In developing countries, what is a major challenge in diagnosing RF?

A

Limited access to medical care

Patients often present with recurrences and established heart disease.

58
Q

What is the significance of echocardiography in patients with advanced RF disease?

A

Its incremental diagnostic benefit is questionable

Many echodetectable cases are also clinically detected within a short follow-up.

59
Q

What is the primary objective in treating acute RF?

A

Eliminating the offending streptococci with antibiotic therapy

Penicillin is the agent of choice.

60
Q

What is a common adverse prognostic indicator in RF patients?

A

Congestive heart failure (CHF)

CHF that does not improve with treatment is associated with the worst prognosis.

61
Q

What valvular lesion may develop late after an acute RF infection?

A

Mitral stenosis

Symptoms often appear only after 20 years, with complications like atrial fibrillation.

62
Q

Fill in the blank: The antibody response to various streptococcal antigens develops within the first month and remains detectable for _______.

A

3–6 months

63
Q

True or False: Echocardiography is universally beneficial for diagnosing RF in developed countries.

A

False

Its routine use has not improved prophylaxis adherence.

64
Q

What is the consequence of valve dysfunction in RF patients?

A

Risk for subacute bacterial endocarditis

Prophylactic antibiotics are recommended before procedures.

Valvular Heart Disease (13 decks)

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