L 11 Rheumatic Fever and Heart Disease

Question 1

Acute Rheumatic fever is which types of disease?

Answer 1

Systemic disease

Question 2

What types of symptoms acute rheumatic fever show?

Answer 2

Arthritis 60-80%
Carditis 30-45% and
Neurological symptoms about 10%

Question 3

If left untreated, a sore throat in 1-3% of cases can lead to

Answer 3

Acute rheumatic fever (ARF) which lead to rheumatic heart disease.

Question 4

RHD is slightly more common in which gender? and which ethnicities?

Answer 4

More common in WOMEN than males, and more common in māori and pacific peoples.

Question 5

Risk factors for rheumatic heart disease

Answer 5

Social inequities like divorce, genetics of both host and bacteria

Question 6

Which protein is responsible to throat infection for sore throat of bacterial genetics

Answer 6

M protein and virulence factor

Question 7

Pathogenesis of ARF(Acute Rheumatic fever)

(Pathogenesis =manner of the development of disease).

Answer 7

GAS throat infection activates (innate and acquired) immune responses.
Thus production of Anti-GAS antibody,which then cross reacts with self tissues and activates cross reactive T cells.

Question 8

Pathology of ARF in joints

Pathology= effects of disease

Answer 8

Immune complex formation, (antibody and synovial proteins)
An influx of inflammatory cells.
Common in LARGE joints along with multiple joints.

Question 9

Pathology of Chorea caused by ARF

Answer 9

Antibody binds to proteins on neurons, altering the signalling and producing increased levels of dopamine.

Chorea = movement disorder causing irregular movements.

Question 10

Pathogenesis of ARF skin pathologies

Answer 10

Antibody cross reacts with keratin.

Question 11

Pathogenesis of ARF carditis. Will there be lasting damage if resolved?

Answer 11

Antibody and T cells respond against heart valve proteins and vascular cell adhesion molecule 1. Inflammatory mediators are released.
Resolution can occur without lasting damage.

Question 12

Which ARF carditis is very severe?

Answer 12

Acute inflammatory pancarditis

Question 13

Pathogenesis of RHD

Answer 13

Mitral and aortic regurgitation and stenosis can progress over time which causes left-side heart failure.

regurgination= something comes back

Question 14

Symptoms of severe acute rheumatic fever

Answer 14

Pain from arthritis
Breathing difficulties from heart failure
High fevers
Jerky and rapid movements

Question 15

If incorrectly treat/overtreat for ARF:

Answer 15

If undertreat for ARF:
Overtreat: unnecessary antibiotic treatment (sometimes for years)
Undertreat: cardiac damage and reduced lifespan

Question 16

Clinical diagnosis for ARF

Answer 16

Non-specific.

WBS, ESR, CRP, ECG, chest x-ray, throat swab

Question 17

Treatment for ARF

Answer 17

Hospitalization for investigations to be done.
Antibiotics + ongoing management of symptoms/complications with paracetamol or naproxen
For Chorea treat with carbamazepine

Question 18

Primary prevention for ARF

Answer 18

Address the underlying causes of disease: economic, social, cultural, behavioral factors.
e.g healthy homes, throat swabs for kids at school

Question 19

Secondary prevention for ARF

Answer 19

Adherence to medicines
Monthly antibiotic injections
Regular cardiology assessments
Influenza + pneumococcal vaccinations.

Question 20

What are the barriers of secondary ARF prevention?

Answer 20

lack of Good information
Pain management by drugs
Lack of Support from whānau and friends
Poor Relationship with district nurses
Personal responsibility for health