B4.013 Prework 2 Rheumatic Heart Disease

Question 1

what is acute rheumatic fever

Answer 1

inflammatory and immunologic disease
usually in kids
follows group A strep pharyngeal infection
valve leaflets deformed by chromic inflammation, fibrosis, and vascular proliferation

Question 2

what causes acute rheumatic fever

Answer 2

autoimmune response to streptococcal antigens (strep O and DNAase B) resulting in cross reaction to myocardial tissue antigens

Question 3

how is acute rheumatic fever diagnosed

Answer 3

Jones criteria

previous group A strep + 2 major or 1 major and 2 minor

Question 4

major jones criteria

Answer 4

migratory polyarthritis in large joints
pancarditis
subcutaneous nodules
erythema marginatum
Sydenham's chores

Question 5

minor jones criteria

Answer 5

fever
arthralgia
increase in ESR or CRP

Question 6

how can you test for previous strep infection?

Answer 6

culture neg but Ab will be detected in serum

Question 7

main cause of mitral stenosis

Answer 7

rheumatic fever

Question 8

what is the pathology of rheumatic heart disease

Answer 8

fibrous adhesions between free edges of cusps and thickening/fusion of mitral leaflets
shortening/thickening/fusion of chordae tendinae
reduction in valve area and increased diastolic P gradient
dilation of LA
a-fib
left atrial appendage thrombus and embolic events
pulm hypertension and right heart failure

Question 9

what does a-fib cause left atrial appendage thrombus

Answer 9

irregular heartbeat leads to stasis of blood and clotting