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Cardiology IPAP > ARF > Flashcards

ARF Flashcards

1
Q

What is the main stay of Symptomatic ARF TXT

A

ASA Children 80-100mg/kg/D Adults 4-8g/D

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2
Q

What age do you see RF

A

5-15yo

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3
Q

Is there a specific TXT for ARF rash?

A

No

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4
Q

Antibodies tested for in RF

A
  1. ASO (antistreptolysin O)
  2. Anti-DNase B 3.ASTZ (antistreptozyme)
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5
Q

Prolonged PRI is due to

A

Early carditis

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6
Q

What new murmur may a RF pt develop

A

Transient (MC) MR or AR

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7
Q

What type of Rx prophylaxis is continuously used?

A

PCN G benzathine (IM) PCN V (PO) Sulfadiazine IF allergic

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8
Q

Sydenham’s chorea is

A

Neurologic D/O of abrupt rapid involuntary nonrhythmic movement (Stops when sleeping)

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9
Q

Prophylaxis for RF w/carditis and w/out valvular disease?

A

Prophylaxis for 10 years or until pt is 21yo

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10
Q

When do you DC TXT

A

Until ALL S/S are gone and ESR/CRP are NL

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11
Q

TXT of carditis

A

TXT HF, Heart block, or valve repair or replacement for nonresponsive HF

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12
Q

DX of ARF requires

A 
Strep evidence 
\+
(Jones)
MAJ  2                                                                                
MAJ  1 + 2 Min
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13
Q

Evidence of GAS inf is

A

POS antibodies (elevated/rising) or POS Cx/Rapid test

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14
Q

What is the most severe sequela of ARF

A

Rheumatic heart DZ

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15
Q

Valvular damage from RF is also known as

A

Rheumatic heart disease

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16
Q

MAJ JONES critera includes

A

J - Joints (Migratory polyarthritis)
O - Carditis
N - nodules (SQ)
E - Erythema marginatum
S - Sydenham’s chorea

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17
Q

Dx tests for RF include

A

Strep A Rapid/CX, Antibody titer CRP and ESR
CXR (Cardiomegaly or HF)
EKG (heart blocks)

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18
Q

Carditis presents as

A

Early in Dz New murmur Pancarditis and friction rub Cardiomegaly

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19
Q

Prophylaxis for RF w/carditis and persistent valve disease?

A

Prophylaxis for 10 years or until pt is 40yo Sometimes lifelong

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20
Q

What is secondline med if unresponsive to ASA

A

CCS (prednisone)

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21
Q

Erythema Marginatum

A

Rash that’s non-pruritic/non-painful eruption raised or flat patches on trunk and prox extremities

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22
Q

RF subQ nodules are

A

Firm painless nodules on wrists, elbows, knees and achilles lasting for 1-2 weeks

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23
Q

RF non-specific S/S

A

Fever
Joint aches Abdominal pain
Weakness
Fatigue

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24
Q

Migratory Poly-arthritis is

A

Severe pain in large joints of extremities w/ rubor, calor, tumor, dolor - lasting <4wks

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25
Q

TXT of ARF consists of

A

ABX, HF management, Anti-inflammatory

26
Q

Pt with RF usually have what hx

A

Pharyngitis associated with scarlet fever or other sequale

27
Q

RF DX based on (Not Definitive)

A

Evidence of GAS infection + POS Jones criteria

28
Q

RF - What usually manifests w/ SubQ nodules

A

Carditis (early RF)

29
Q

If patient has PCN allergy what Rxs to use?

A

Macrolides (Azithromycin, Clarithromycin, Clindamycin)

30
Q

In what order does heart blocks appear in ARF?

A
  1. Complete heart block 2. 2nd degree heart block 3. 1st degree heart block (Long PRI) 4. Normal Sinus rhythm
31
Q

75% pts w/ RF usually have

A

Migratory Poly-arthritis

32
Q

Prophylaxis for RF w/out carditis?

A

Prophylaxis for 5 years until 21yo

33
Q

Which valves are most commonly affected in order

A

(MC) Mitral Aortic (can be common) Tricuspid (rare)

34
Q

Presumptive RF dx made if (3)

A
  1. Sydenham’s Chorea is only manifestation 2. Indolent carditis (pt fails to get TXT)
  2. Recurrent RF w/ ARF with any manifestation
35
Q

What valves can be affected by ARF

A

Mitral, Aortic, tricuspid

36
Q

What two S/S of ARF resolve the quickest

A

Polyarthritis and carditis

37
Q

What is a common EKG finding of carditis

A

Heart block

38
Q

RF specific S/S

A

Arthritis in joints but evolves one at a time ABNL heart beat Chest Pain Red patches on skin Small painless lumps beneath skin

39
Q

What may be the sole manifestation of ARF in an unTXT pt?

A

Indolent carditis

40
Q

Is there TXT for RF progressive valvular damage?

A

No

41
Q

Minor jones criteria

A

Arthralgias (without arthritis) Fever: 101F to 104F Elevated acute phase reactants (ESR and CRP) Prolonged PR Interval on ECG

42
Q

What is the latent period before ARF S/S after a GAS infection?

A

f3 Wks

43
Q

What does ARF prevention consist of

A

Primary -Prompt Dx and ABX of GAS pharyngitis Secondary - GAS Prophylaxis

44
Q

Acute RF is

A

A delayed, non-suppurative sequelae of a pharyngeal GAS infection

45
Q

When do you switch from IM PCN to PO?

A

Young adult hood and has remaied free of rheumatic attacks

46
Q

ABX TXT of RF

A

1st line Penicillin for 10D

47
Q

Can RF occur from GAS skin infection?

A

No

48
Q

50% of pts with RF have

A

Carditis (early RF)

49
Q

Another name for sydenham’s chorea?

A

St. Vitus dance

50
Q

Generally what is the time frame of heart block progression

A

18D

51
Q

Goals of RF treatment

A

S/S relief Eradicate/Prophylaxis GAS

52
Q

How long can valvular damage set in from RF?

A

10-30 years

53
Q

What is the least common S/S of RF

A

SQ nodules

54
Q

What two Major S/S present early in DZ?

A

Poly-arthritis and Carditis (Resolve quickly too)

55
Q

What major S/S of ARF peaks at 2.5 months?

A

Nodules (SQ)

56
Q

What does Syndenhams Chorea start? And how long?

A

Later and longer

57
Q

Can anything slow the progression of valvular damage?

A

NO

58
Q

What is Primary PVT of ARF?

A

Prompt DX and TXT

59
Q

What is Secondary PVT of ARF?

A

Prophylaxis

60
Q

MC new murmur associated with RF

A

MR 1st then AR

61
Q

What murmur commonly develops w/ RHD?

A

MS 1st then AS (Rarely TS)

Cardiology IPAP (20 decks)

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