ARF Flashcards
What is the main stay of Symptomatic ARF TXT
ASA Children 80-100mg/kg/D Adults 4-8g/D
What age do you see RF
5-15yo
Is there a specific TXT for ARF rash?
No
Antibodies tested for in RF
- ASO (antistreptolysin O)
- Anti-DNase B 3.ASTZ (antistreptozyme)
Prolonged PRI is due to
Early carditis
What new murmur may a RF pt develop
Transient (MC) MR or AR
What type of Rx prophylaxis is continuously used?
PCN G benzathine (IM) PCN V (PO) Sulfadiazine IF allergic
Sydenham’s chorea is
Neurologic D/O of abrupt rapid involuntary nonrhythmic movement (Stops when sleeping)
Prophylaxis for RF w/carditis and w/out valvular disease?
Prophylaxis for 10 years or until pt is 21yo
When do you DC TXT
Until ALL S/S are gone and ESR/CRP are NL
TXT of carditis
TXT HF, Heart block, or valve repair or replacement for nonresponsive HF
DX of ARF requires
Strep evidence \+ (Jones) MAJ 2 MAJ 1 + 2 Min
Evidence of GAS inf is
POS antibodies (elevated/rising) or POS Cx/Rapid test
What is the most severe sequela of ARF
Rheumatic heart DZ
Valvular damage from RF is also known as
Rheumatic heart disease
MAJ JONES critera includes
J - Joints (Migratory polyarthritis)
O - Carditis
N - nodules (SQ)
E - Erythema marginatum
S - Sydenham’s chorea
Dx tests for RF include
Strep A Rapid/CX, Antibody titer CRP and ESR
CXR (Cardiomegaly or HF)
EKG (heart blocks)
Carditis presents as
Early in Dz New murmur Pancarditis and friction rub Cardiomegaly
Prophylaxis for RF w/carditis and persistent valve disease?
Prophylaxis for 10 years or until pt is 40yo Sometimes lifelong
What is secondline med if unresponsive to ASA
CCS (prednisone)
Erythema Marginatum
Rash that’s non-pruritic/non-painful eruption raised or flat patches on trunk and prox extremities
RF subQ nodules are
Firm painless nodules on wrists, elbows, knees and achilles lasting for 1-2 weeks
RF non-specific S/S
Fever
Joint aches Abdominal pain
Weakness
Fatigue
Migratory Poly-arthritis is
Severe pain in large joints of extremities w/ rubor, calor, tumor, dolor - lasting <4wks
TXT of ARF consists of
ABX, HF management, Anti-inflammatory
Pt with RF usually have what hx
Pharyngitis associated with scarlet fever or other sequale
RF DX based on (Not Definitive)
Evidence of GAS infection + POS Jones criteria
RF - What usually manifests w/ SubQ nodules
Carditis (early RF)
If patient has PCN allergy what Rxs to use?
Macrolides (Azithromycin, Clarithromycin, Clindamycin)
In what order does heart blocks appear in ARF?
- Complete heart block 2. 2nd degree heart block 3. 1st degree heart block (Long PRI) 4. Normal Sinus rhythm
75% pts w/ RF usually have
Migratory Poly-arthritis
Prophylaxis for RF w/out carditis?
Prophylaxis for 5 years until 21yo
Which valves are most commonly affected in order
(MC) Mitral Aortic (can be common) Tricuspid (rare)
Presumptive RF dx made if (3)
- Sydenham’s Chorea is only manifestation 2. Indolent carditis (pt fails to get TXT)
- Recurrent RF w/ ARF with any manifestation
What valves can be affected by ARF
Mitral, Aortic, tricuspid
What two S/S of ARF resolve the quickest
Polyarthritis and carditis
What is a common EKG finding of carditis
Heart block
RF specific S/S
Arthritis in joints but evolves one at a time ABNL heart beat Chest Pain Red patches on skin Small painless lumps beneath skin
What may be the sole manifestation of ARF in an unTXT pt?
Indolent carditis
Is there TXT for RF progressive valvular damage?
No
Minor jones criteria
Arthralgias (without arthritis) Fever: 101F to 104F Elevated acute phase reactants (ESR and CRP) Prolonged PR Interval on ECG
What is the latent period before ARF S/S after a GAS infection?
f3 Wks
What does ARF prevention consist of
Primary -Prompt Dx and ABX of GAS pharyngitis Secondary - GAS Prophylaxis
Acute RF is
A delayed, non-suppurative sequelae of a pharyngeal GAS infection
When do you switch from IM PCN to PO?
Young adult hood and has remaied free of rheumatic attacks
ABX TXT of RF
1st line Penicillin for 10D
Can RF occur from GAS skin infection?
No
50% of pts with RF have
Carditis (early RF)
Another name for sydenham’s chorea?
St. Vitus dance
Generally what is the time frame of heart block progression
18D
Goals of RF treatment
S/S relief Eradicate/Prophylaxis GAS
How long can valvular damage set in from RF?
10-30 years
What is the least common S/S of RF
SQ nodules
What two Major S/S present early in DZ?
Poly-arthritis and Carditis (Resolve quickly too)
What major S/S of ARF peaks at 2.5 months?
Nodules (SQ)
What does Syndenhams Chorea start? And how long?
Later and longer
Can anything slow the progression of valvular damage?
NO
What is Primary PVT of ARF?
Prompt DX and TXT
What is Secondary PVT of ARF?
Prophylaxis
MC new murmur associated with RF
MR 1st then AR
What murmur commonly develops w/ RHD?
MS 1st then AS (Rarely TS)
