rheumatic fever Flashcards
cause of RF?
pharyngeal infection from group A beta hemolytic streptococcus after 3 weeks
pathology?
cross reaction between body immune response to streptococcal antigens and heart tissue antigens
peak age?
5-15 peak is 8 years
organ involved?
skin. heart, lungs, vessels, joints
most common valve affected?
mitral 70-80%
aortic 30%
tricuspid and pulmonary 5%
sequel of acute rheumatic carditis?
chronic heart failure
jones criteria?
minor: fever, arthralgia, previous rheumatic fever, raised ESR, leukocytosis, prolonged pR intervel
major: carditis, polyarthritis, chorea, erythema marginatum, nodules
previous strep pharyngitis histoyr with 2 major or 1 major+2 minor
D/D of fever plus joint pain?
lyme disease brucellosis miliary tuberculosis cat scratch disease staph arthritis sle serum sickness gonococcal and meningococcal arthritis rheumatoid arthritis
features of carditis?
mostly occur in childern 40-60% sinus tachycardia murmur carey coombs murmur( mid diastolic murmur) s3 gallop cardiomegaly 2nd or 3rd degree heart block ecg raised st segment. flattened T wave
what is migratory polyarthritis?
one joint affected then other, affect large joint like knee elbow wrist, ankles
joints are swollen red and tender subside in 2–3 weeks
complications of RF?
pericarditis pericarditis effusion congestive heart failure arrhythmias rheumatic pneumonia rheumatic heart disease
innvestigation?
mainly clinical
throat swab but usually negative after 3 weeks
antistreptolysin 0 titer elevated in 80 % cases
ESR and CRP
blood cbc
chest xray
ECG
management?
bed rest until temp normal, esr return, pulse rate less than 100
ECG toches baseline
aspirin for joint pain
corticosteriods
primary prevention?
prompt treatment of pharyngitis with benzathine penicillin
erythromycin and azithromycin if penicillin allergic
secondary prevention?
means prevention from recurrence
RF with carditis and residual valvular disease: life long prophylaxis
RF with carditis: 10 years
RF with no carditis: 5 years or until 21 years age
