Acute Rheumatic Fever & Rheumatic Heart Disease

Question 1

Rheumatic Fever: Basics

Answer 1

• Diffuse, inflammatory disease caused by a delayed immune response to infection by the GABHS
• Febrile illness
• Inflammation of the joints, skin, nervous system, and heart
• If left untreated, causes rheumatic heart disease
• # 1 cause of valve replacement in elderly today due to lack of swift treatment

Question 2

RF: Clinical Findings

Answer 2

• Carditis: Murmur, chest pain, extra heart sounds, abnormal EKG
• Polyarthritis: Migraotry inflammation of >1joint; usually large joints for 3wk; subcutaneous nodules can develop over bony prominences with heat, redness, swelling, and pain
• Chorea: sudden, aimless, irregular involuntary movement for up to 6mo
• Erythema marginatum: truncal rash, non-puritic; pink macules that never occur on face and hands; transitory; darkens with temperature change

Question 3

RF: Dx

Answer 3

• Throat culture for strep (may be neg. by the time RF starts)
• ***ASLO titers: always elevated
• CBC-Diff
• ESR
• CRP
• ECG: prolonged PRI
• Chest XR
• Echocardiogram
• Presence of scarlet fever (esp. peeling hands or feet) is strong Dx aid

Question 4

RF: Tx

Answer 4

• ABX (PCN, Cephalosporin)
• Antiinflammatories: ASA for arthritis for 2wk and then tapered
• Steroids for severe carditis
• Flu Vacc
• Bedrest
• Carbamazepine/valproate for chorea
• ABX prophylaxis is continued for 5yr with carditis or until age 21; if valve DZ may be for 10yr-lifetime
• Dental prophylaxis

Question 5

RF: Resolution

Answer 5

Active disease considered resolved when:

• murmur is gone and cardiac status is stable
• Major manifestations are no longer present
• Individual is afebrile
• ESR in NL or stable
• May take 6mo
• May require surgical valve repair/replacement