ARF and RHD Flashcards
What is ARF and what may it lead to?
An autoimmune response to GAS infection of the upper respiratory tract.
May lead to damage of the mitral/aortic valves which is known as Rheumatic Heart disease
Explain the pathogenesis of ARF?
Usually susceptible host (ATSI person), infected, takes 3 weeks to develop. By the time the symptoms develop, the infecting strain of GAS has usually been eradicated from the hosts body
Whats the epidemiology of RHD?
Mainly affects ATSI people, most cases affect developing countries
ATSI people are x8 more likely to be hospitalised from the disease
What is the primary prevention for ARF/RHD?
Stop the development of risk factors for a disease in a population. Done by:
reducing GAS transmission, acquisition, colonisation and carriage, or treating GAS infection effectively to prevent the development of ARF in individuals
this is done by:
targeting measures such as environmental, economic, social and behaviour conditions and cultural patterns
e.g. getting them to maintain hygiene, prevent overcrowding and poverty, improving skin health
basically targeting the population in Australia that are more at risk
What is an acurate diagnosis important in RHD?
Overdiagnosis results in unnecessary treatment over a long time whilst under diagnosis relsuts to futher attacks of ARF and long term complications
What is used to diagnose ARF?
ECG
or can refer to specialist
What is the management for ARF?
No treatments offered for ARF have been proven to alter the outcome of the acute episode or amount of damage to heart valves.
But non-steroidal anti-inflammatory drugs reduce pain of arthritis caused by ARF and fever.
Paracetamol and codeine can also be used for pain relief.
Basically patients suspected of ARF should be hosptialised
What is secondary prevention of RHD and what treatments do they do for it?
Refers to early detection of disease and implementing measures to prevent worsening of it.
Done by four-weekly BPG injections, except those at high risk who get 3 in one week over 3 weeks.
What are some problems with the secondary prophylaxis?
Reduced adherence, as people have to travel every week.
Also injections are quite painful and are usually administered to kids, therefore reduced compliance of patient.
What are some strategies to improving adherence of secondary prophylaxis/
Identifying local and dedicated staff to administer treatment
Improve relationships with patient/family
support using aboriginal health workers
develop and implement recall and reminder system
What are the major and minor manigestations of ARF?
Carditis (inflammation of heart)
Chorea (neurological disorder which causes jerky movements)
polyarthritis (arthritis in joints)
Minor:
fever
pain in joints
What are some of the clinicical points used to diagnose ARF? (x5)
