Cardio2 Flashcards
What are the jones major criteria for RF?
C arditis A rthritis (migratory polyarthritis) S (C) sydenham Chorea E rythema Marginatum S ubcutaneous nodule
What are the Jones minor criteria?
o Arthralgia (in the absence of polyarthritis as a major criterion) o Fever (typically temperature of 102°F and occurring early in the course of illness)
LABORATORY
o Elevated acute-phase reactants (e.g., C-reactive protein, erythrocyte sedimentation rate)
o prolonged PR interval on electrocardiogram (1st degree heart block)
What is the Absolute Requirement for the diagnosis of RF?
Recent Group A Streptococcus Infection based on elevated or increasing serum antistreptococcal antibody titers
antistreptolysin O
What are the 3 circumstances in which the diagnosis of ARF can be made without strict adherence to the Jones criteria?
o Chorea as the only manifestation
o Indolent carditis may who 1st come to medical attention months after the onset of ARF.
o Finally, although most patients with recurrences of ARF fulfill the Jones criteria, some may not
What is the universal finding in rheumatic carditis?
Endocarditis (valvulitis)
Most common Valvular lesions in RF?
mitral valve> aortic valve> (right sided valves: tricuspid and pulmonic)
Heard as
o Mitral regurgitation: pitched apical holosystolic murmur radiating to the axilla
o Aortic insufficiency: high-pitched decrescendo diastolic murmur at the upper left sternal border
Treatment for RF
ANTIBIOTICS
o 10 days of orally administered penicillin or erythromycin or a single intramuscular injection of benzathine penicillin to eradicate GAS from the upper respiratory tract
o benzathine penicillin G (600,000 IU for children 60 lb and 1.2 million IU for those 60 lb) every 4 wk until the patient reaches 21 yr of age or until 5 yr have elapsed since the last rheumatic fever attack, whichever is longer.
o alternative: penVK or macrolide
ANTIINFLAMMATORY
o Aspirin dosage: 100 mg/kg/day in 4 divided doses PO for 3-5 days followed by 75 mg/kg/day in 4 divided doses PO for 4 wk
o Prednisone dosage: 2 mg/kg/day in 4 divided doses for 2-3 wk followed by a tapering of the dose that reduces the dose by 5 mg/24 hr every 2-3 days for cardiomegaly or CHF
o salicylates & corticosteroids should be withheld if arthralgia or atypical arthritis is the only clinical manifestation which may interfere with the development of the characteristic migratory polyarthritis
o paracetamol for pain relief
Treatment for Sydenham Chorea of RF
o Phenobarbital (16-32 mg every 6-8 hr PO) is the drug of choice
o If phenobarbital is ineffective, then haloperidol (0.01-0.03 mg/kg/24 hr divided bid PO) or
o Chlorpromazine (0.5 mg/kg every 4-6 hr PO) should be initiated
Most common valvular involvement in children with RHD
Mitral Insufficiency
Characteristic heart murmur in RHD with mild Mitral Insufficiency
high-pitched holosystolic murmur at the apex that radiates to the axilla
Most common valvular involvement in adults with RHD
Mitral Stenosis
-usually takes 10 yr or more for the lesion to become fully established
an apical presystolic murmur resembling that of mitral stenosis sometimes heard and is a result of the large regurgitant aortic flow in diastole preventing the mitral valve from opening fully in RHD with aortic insufficiency
Austin Flint murmur
murmur in pulmonary insufficiency secondary to RHD which is similar to that of aortic insufficiency, but with absent peripheral arterial signs (bounding pulses).
Graham Steell murmur
Define Sinus bradycardia in
A. Neonates
B. Older children
A. Neonates: HR <60
Treatment for PVC
Correct underlying cause
IV lidocaine
Amiodarone
-intravenous lidocaine bolus and drip is the 1st line of therapy, with more effective drugs such as amiodarone reserved for refractory cases or for patients underlying ventricular dysfunction or hemodynamic compromise.
