Rheumatic Fever Flashcards
multisystem inflammatory disease resulting from an autoimmune reaction to infection with group A Streptococcus
Acute rheumatic fever (ARF)
Many parts of the body may be affected, The major exception is cardiac valvular damage (rheumatic heart disease [RHD])
all of the manifestations resolve completely except cardiac valvular damage which may persist after the other features have disappeared
usually presents with fever, anorexia, lethargy and joint pain, 2–3 weeks
after an episode of streptococcal pharyngitis
Acute rheumatic fever
usually affects children and young adults between the ages of 5 and 15 years
Acute rheumatic fever
remains endemic in the Indian subcontinent, Africa and South America
Acute rheumatic fever
have antigens that cross-react with cardiac myosin and sarcolemmal membrane proteins
Streptococci
Antibodies produced against the streptococcal antigens cause inflammation in the endocardium, myocardium and as well as the joints, skin and Brain
Cause of rheumatic fever
Rheumatic fever causes a
pancarditis
pancarditis involving
endocardium, myocardium and pericardium to varying degrees
Poverty
A risk factors for rheumatic fever
Overcrowding
A risk factors for rheumatic fever
limited access to medical care
A risk factors for rheumatic fever
Rheumatic fever and resulting endocarditis can cause damage to
heart valves
heart valves damage caused by Rheumatic fever and endocarditis are …….. (4)
Mitral or Tricuspid regurgitation
Mitral valve prolapse
Aortic regurgitation
Mitral stenosis
Rh. fever Signs and Symptoms Result from …….. in ……
inflammation
the heart, joints, skin or
central nervous system
Fever,anorexia or fatigue
Rh. Fever symptom
Arthralgia (joint pain)
Rh. fever symptom
Arthritis[seenin75%patients]
Rh. fever symptom
Carditis
Rh. fever symptom
CNS manifestation
Rh. fever symptom
Skin manifestation
Rh. fever symptom
There may not be any history of sore throat.
Rh. fever
Painful and tender joints
Arthritis
Arthritis Most often in
ankles, knees, wrists, elbows, hip or
shoulders [in order of frequency]
Pain in one joint that migrates to another joint.
Migratory poly arthritis
The process of migration lasts for ………
3-6 weeks
Red, hot or swollen joints but not deforming
Arthritis
Arthritis in Rh. Fever do not progress to
chronic arthritis
involves the endocardium (including valves), myocardium and pericardium to varying degrees.
Carditis (pancarditis)
Breathlessness, Chest pain and Palpitation
Symptoms of Carditis (pancarditis)
Patient may look ill, tired or dyspneic
Cardiac signs of acute Rh. Fever
Tachycardia or irregular pulse
Cardiac signs of acute Rh. Fever
New murmur or Change in old cardiac murmur
Cardiac signs of acute Rh. Fever
soft systolic murmur is very common
due to mitral regurgitation
Cardiac signs of acute Rh. Fever
Tricusp valve (TV) and Pulmonary valve (PV) are rarely involved in
Cardiac signs of acute Rh. Fever
Precordial tenderness
Cardiac signs of acute Rh. Fever
Pericardial friction rub
Cardiac signs of acute Rh. Fever
Heart failure is ….
Due to ….
Cardiac signs of acute Rh. Fever
myocarditis or valves dysfunction.
Raised JVP ,legs edema, 3rd Heart sound and gallop rhythm
Symptoms of Heart failure
one-quarter of affected patients will develop
chronic rheumatic valvular heart disease
Which side of the heart usually affected
left side of the heart (Mitral valve and aortic valve)
left side of the heart is affected (Mitral valve and aortic valve) called as …..
Rheumatic Heart Disease
Subcutaneous nodules
Skin manifestation of Rh fever
Small (0.5-2cm),painless nodules under the skin
Subcutaneous nodules
Seen in 7% of patients
Subcutaneous nodules
It’s present on the extensor surface of bone and tendons
Subcutaneous nodules
Subcutaneous nodules typically appear ….
more than 3 weeks after others signs
Erythema marginatum
Skin lesion may appear in Rh fever
Seen in less than 5%
Erythema marginatum
Flat or slightly raised, painless rash
Erythema marginatum
Seen mainly on the trunk and proximal extremities but not on the face
Erythema marginatum
Sydenham chorea (St. Vitus dance)
CNS manifestation
purposeless, involuntary , repetitive, jerky and rapid, movements of the hands, feet or face
Sydenham chorea(St. Vitus dance)
late neurological manifestation that appears at least 3 months after the episode of acute rheumatic fever, when all the other signs may have disappeared
Sydenham chorea(St. Vitus dance)
occurs in up to one-third of cases and is more common in females
Sydenham chorea(St. Vitus dance)
Carditis
Major manifestation
Poly arthritis
Major manifestation
Chorea
Major manifestation
Erythema marginatum
Major manifestation
Subcutaneous nodules
Major manifestation
Fever
Minor manifestation
Arthralgia
Minor manifestation
Raised erythrocyte sedimentation rate / C-reactive protein
Minor manifestation
Previous rheumatic fever
Minor manifestation
Leukocytosis
Minor manifestation
1st-degree atrioventricular block
Minor manifestation
To diagnose rheumatic fever
Must be evidence of recent strep infection plus 2 major criteria, or 1 major + 2 minor
Leucocytosis
Evidence of a systemic illness
Raised erythrocyte sedimentation rate
Evidence of a systemic illness
C-reactive protein
Evidence of a systemic illness
Throat swab culture group A beta-hemolytic streptococci
Evidence preceding streptococcal infection
Antistreptolysin O antibioties (ASO titres)
Rising titres, or levels of > 200 U for adults or > 300 U for children
Evidence preceding streptococcal infection
Chest X-ray
To detect …..
Evidence of carditis
Cardiomegaly , pulmonary congestion
ECG
To detect………
Evidence of carditis
1st-degree atrioventricular block
2nd-degree atrioventricular block (rarely)
Features of pericarditis
T wave inversion
Reduction inQRS voltage
Echocardiography
Evidence of carditis
Cardiac dilatation
Vale abnormalities
aims of management are
to limit cardiac damage and relieve symptoms.
Bed rest Bed
Management of Rh fever
Treatment of cardiac failure [If any]
Antibiotic therapy: Benzathine benzylpenicillin
Management of Rh fever
Aspirin
Management of Rh fever
relieves the symptoms of arthritis
Steroids [Prednisolone]
Management of Rh fever
Rapid symptomatic relief than
aspirin
indicated in cases with carditis or severe arthritis.
Steroids [Prednisolone]
