Acute Rheumatic Fever + IE

Question 1

ECG changes for Acute Rheumatic Fever

Answer 1

Prolonged PR interval due to abnormal atrioventricular conduction

Question 2

Major criteria for Acute Rheumatic Fever

Answer 2

Pancarditis
Arthritis (migratory polyarthritis)
Subcutaneous nodules
Sydenham chorea
Erythema marginatum

Question 3

Minor criteria for Acute Rheumatic Fever

Answer 3

Fever
Arthralgia
Increased PR
Labs - elevated CRP/ESR

Question 4

ARF Criteria

Answer 4

1-2 major criteria + 2 minor criteria + evidence of preceding GAS infection

Question 5

How to detect previous GAS infection?

Answer 5

1) Increased or rising anti-streptolysin O titre or anti-DNAase B
2) Positive throat culture for group A beta-haemolytic streptococcus
3) Positive group A streptococcus carbohydrate antigen test in patient with a high pre-test probability

Question 6

Which ECG findings is associated w/ aortic root abscess?

Answer 6

Prolonged PR interval

Question 7

Indications for surgical management for IE

Answer 7

Emergency
- Severe acute regurgitation causing refractory pulmonary oedema, cardiogenic shock

Urgent
- Severe acute regurgitation causing heart failure
- Locally uncontrolled infection - abscess, enlarging vegetation, prosthetic dehiscence
- Persistent vegetation > 10mm after 1 or more embolic events on appropriate ABx therapy
- Positive BC > 1 week (IIa)
- PVE caused by staph aureus or non-HACEK organisms (IIb)

Question 8

Culture-negative organisms for infective endocarditis

Answer 8

Coxiella (Q fever)
Bartonella (cat scratch)
Brucella
Legionella
Whipple’s disease