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Year One - Cardiovascular System > Rheumatic Fever > Flashcards

Rheumatic Fever Flashcards

1
Q

What is rheumatic fever?

A

It is defined as a systemic inflammatory disorder, which is related to recent infection with Group A Streptococcus

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2
Q

What Group A Streptococcus organism is associated with rheumatic fever?

A

Streptococcus Pyogenes

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3
Q

Is rheumatic fever contagious?

A

No

However, the initial Group A Streptococcus infection is contagious

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4
Q

Describe the pathophysiology of rheumatic fever

A

The initial Streptococcus infection produces a type II hypersensitivity reaction via molecular mimicry

This is due to similarities in the molecular structure of the streptococcal bacteria cell walls and human heart valve tissue, resulting in the body’s antibodies attacking the host instead of the pathogen

This leads to permanent damage to the heart’s valves, resulting in formation of granulomatous nodules

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5
Q

What term is used to refer to the granulomatous nodules formed in rheumatic fever?

A

Aschoff bodies

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6
Q

Which five risk factors are associated with rheumatic fever?

A

Children 5 – 15 Years Old

Female Gender

Family History

Immunocompromised

Group A Streptococcus Infection

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7
Q

What are the six clinical features of rheumatic fever?

A

Streptococcus Infection Features

Polyarthritis

Carditis Features

Sydenham’s Chorea

Erythema Marginatum

Subcutaneous Nodules

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8
Q

Describe the polyarthritis associated with rheumatic fever

A

Fleeting arthritis

This describes arthritis that migrates from one joint to another within a period of one to two months

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9
Q

What is carditis?

A

It is defined as inflammation of the heart - involving one or all of the three layers

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10
Q

What are the three layers of the heart?

A

Endocardium

Myocardium

Pericardium

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11
Q

How does endocarditis tend to present?

A

Valvular heart disease

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12
Q

Which heart valve is most commonly affected by rheumatic fever?

A

Mitral valve

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13
Q

What are the five murmur features of mitral regurgitation?

A

Holosystolic, High Pitched, Whistling Murmur

Murmur Radiation To Axilla

Quiet, Soft S1

S3 Sound

Widely Split S2

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14
Q

What are the five murmur features of mitral stenosis?

A

Mid-Diastolic, Low Pitched, Rumbling Murmur

Louder Murmur on Expiration

Loud S1

Tapping Apex Beat

Low Volume Pulse

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15
Q

How does myocarditis tend to present?

A

Heart failure

It therefore usually presents as dyspnoea, orthopnea and oedema

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16
Q

How does pericarditis tend to present?

A

Pericardial rub

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17
Q

What is Sydenham’s chorea?

A

It is defined as involuntary, semi-purposeful movements of the body

In some cases, the chorea is preceded by emotional behaviour which is out of character

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18
Q

When does Sydenham’s chorea tend to present in rheumatic fever?

A

It is a late clinical feature, which usually presents 2 - 6 months after the initial streptococcal infection

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19
Q

What is erythema marginatum?

A

It is defined as a pink macular rash predominantly affecting the trunk and limbs

It expands outwards, leaving a pale centre

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20
Q

What are subcutaneous nodules?

A

They are defined as hard, mobile, painless pea-sized masses

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21
Q

In which two regions are subcutaneous nodules usually located?

A

Extensor surfaces

Spine

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22
Q

Which three investigations are used to diagnose rheumatic fever?

A

Blood Tests

Throat Swabs

ECG Scan

23
Q

What six blood test results are indicative of rheumatic fever?

A

Increased WCC Levels

Increased ESR Levels

Increased CRP Levels

Increased Troponin Levels

Increased Anti-Streptolysin O (ASO) Levels

Increased Anti-DNAse B Levels

24
Q

Which two antibodies are associated with rheumatic fever?

A

Anti-Streptolysin O (ASO)

Anti-DNAse B

25
Q

How are throat swabs used to diagnose rheumatic fever?

A

They are used to identify Group A Streptococcus infection

This can either be obtained through a bacterial culture or rapid streptococcal antigen test (RAST)

26
Q

What are the two features of rheumatic fever on ECG scans?

A

Tachycardia

Prolonged PR Interval

27
Q

Which criteria is referred to in order to diagnose rheumatic fever?

A

Jones criteria

28
Q

What does Jones criteria state?

A

It states that individuals must present with…

Streptococcus Infection Features

PLUS

Two Major Criteria

OR

One Major Criterion & Two Minor Criteria

29
Q

What are the four features of streptococcus infection?

A

Positive Throat Swab

Positive Rapid Streptococcal Antigen Test (RAST)

Increased Streptococcal Antibody Titre

Recent Scarlet Fever Episode

30
Q

What are the five major criteria in the ‘Jone’s Criteria’?

A

Polyarthritis

Carditis Features

Sydenham’s Chorea

Erythema Marginatum

Subcutaneous Nodules

31
Q

What are the five minor criteria in the ‘Jone’s Criteria’?

A

Polyarthralgia

Prolonged PR Interval

Rheumatic Fever History

Fever > 39°C

Increased Inflammatory Markers

32
Q

What is the conservative management option of rheumatic fever?

A

Bedrest

33
Q

What is the first line management option of rheumatic fever?

A

Bedrest

34
Q

How long do we recommend rheumatic fever patients follow bedrest advice for?

A

It is usually recommended until the CRP levels have returned to the normal range for at least two weeks

35
Q

What are the three pharmacological management options of rheumatic fever?

A

Antibiotics

NSAIDs

Corticosteroids

36
Q

How are antibiotics used to manage rheumatic fever?

A

They are used to treat the causative streptococcal infection

37
Q

What is the first line antibiotic used to manage rheumatic fever?

A

Penicillin

38
Q

What dose of penicillin is used to manage rheumatic fever?

A

A single stat dose of IV benzylpenicillin

This is then followed by oral phenoxymethylpenicillin for a course of ten days

39
Q

What are the two second line antibiotics used to manage rheumatic fever?

A

Erythromycin

OR

Azithromycin

40
Q

When are NSAIDs used to manage rheumatic fever?

A

They are the first line pharmacological management option used to limit the inflammatory response

41
Q

Name an NSAID used to manage rheumatic fever

A

Aspirin

42
Q

Why do we need to monitor the administration of aspirin in children?

A

This is due to the associated complications of respiratory alkalosis, metabolic acidosis, tinnitus and Reye’s syndrome

43
Q

When are corticosteroids used to manage rheumatic fever?

A

They are the second line pharmacological management option used to limit the inflammatory response

44
Q

Name a corticosteroid used to manage rheumatic fever

A

Prednisolone

45
Q

How do we prophylactically manage rheumatic fever?

A

Antibiotics

46
Q

What antibiotic is the first line prophylactic management option of rheumatic fever?

A

Benzathine penicillin G

47
Q

How is benzathine penicillin G administered to prophylactically manage rheumatic fever?

A

It is administered every four weeks as an intramuscular injection

48
Q

What antibiotic is the second line prophylactic management option of rheumatic fever?

A

Phenoxymethylpenicillin

49
Q

How is phenoxymethylpenicillin administered to prophylactically manage rheumatic fever?

A

It is administered once daily as an oral tablet

50
Q

What antibiotic is the third line prophylactic management option of rheumatic fever?

A

Macrolide antibiotics

51
Q

Name two macrolide antibiotics used to prophylactically manage rheumatic fever

A

Erythromycin

Azithromycin

52
Q

How are macrolide antibiotics administered to prophylactically manage rheumatic fever?

A

They are administered once daily as an oral tablet

53
Q

What are the seven complications of rheumatic fever?

A

Rheumatic Heart Disease

Infective Endocarditis

Heart Failure

Pericardial Effusions

Valvular Heart Disease

Atrial Fibrillation

Pulmonary Hypertension

Year One - Cardiovascular System (20 decks)

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