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Cardiology > Rheumatic fever > Flashcards

Rheumatic fever Flashcards

1
Q

RF

Age group

A

in children and young adults (5- 15 years)

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2
Q

RF

MOs

A

Group A beta hemolytic strep pyogenes

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3
Q

RF

Strep pyogenes can cause

A

Skin infection
Pharyngitis

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4
Q

RF

Rheumatic fever occurs after

A

pharyngitis

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5
Q

RF

Type of immune reaction seen in RF

A

Type 2 auto immune

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6
Q

RF

Type 2 Autoimmune reaction

A

Mediated by Ab. Body produces Ab againts the M protein on MOs. The body itself has proteins similar to M protein. So the Ab will attack the body’s Proteins ( Molecular mimicry)

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7
Q

RF

Type I Autoimmune reaction

A
  • IgE mediated mast cells.
  • histamine
  • eg- anaphylaxis
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8
Q

RF

Type 3 Autoimmune reaction

A

mediated by Ag- Ab complex. this complex will deposit on cells and activate compliments. This causes the reaction
* Eg- SLE

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9
Q

RF

Type 4 autoimmune reaction

A
  • delayed- type hypersensitivity by T cells
  • Eg- TB, Type 1 Diabetes
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10
Q

RF

Type 5 autoimmune reaction

A
  • mediated by organ specific Ab
  • eg- myasthenia gravis, Grave’s disease
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11
Q

RF

Aschoff nodules

A
  • Pathognomic
  • Multinucleate giant cells sorrounded by T cells and macrophages
  • Seen in subacute or chronic RF
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12
Q

RF

Dx criteria

A

Revised jones criteria

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13
Q

RF

Major criteria

A
  • Polyarthritis
  • Carditis
  • Chorea
  • Erythema marginatum
  • subcutaneous nodules
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14
Q

RF

Minor criteria

A
  • fever
  • Arthralgia
  • Previoys RF or rheumatic heart disease
  • increased acute phase reactants
  • Prolonged PR interval
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15
Q

RF

Polyarthritis

A

fleeting polyarthritis (migratory) affecting large joints
DOES NOT CAUSE PERMANENT DAMAGE

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16
Q

RF

Carditis

A

Pancarditis but myocarditis and pericarditis without endocarditis is rare.
MAY CAUSE PERMANENT DAMAGE

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17
Q

RF

Which side is most commonly affected in carditis

A

L/S> R/S

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18
Q

RF

Chorea

A
  • emotional lability
  • incoordination
  • poor school performance
  • uncontrolled movement
  • facial grimacing
  • milk maid grip
  • dancing pupils
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19
Q

RF

Chorea is affecting

A

children more than the elderly
Females more than males

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20
Q

RF

Chorea is seen

A
  • 1- 6 months after the infection.
  • late feature
  • usually no permanent damage
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21
Q

RF

Subcutaneous nodules

A

painless pea shaped hard nodules beneath skin, extensor surface of tendons near bony surfaces

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22
Q

RF

Erythema marginatum

A

transient pink rash with raised edges** (which does not involve the face)**

23
Q

RF

To Dx RF from revised jones criteria

A
  • 2 or more major
  • 1 major + 2 minor + evidence of strep infection
24
Q

RF

How to Dx Strep

A
  • positive throat culture for Group A beta hemolytic strep
  • Elevated ASOT >250 IU
  • Hx of recent scarlet fever
25
Q

RF

ASOT

A

Anti- streptolysin “O” titre

26
Q

RF

Rheumatic vegetations

A
  • small
  • single/ multiple
  • DO NOT EMBOLIZE
  • STERILE
27
Q

RF

Which side of the heart is affected more

A
  • left side is affected more. MV is affected causing mitral stenosis
  • Isolated aortic V involvement is rare
28
Q

RF

Does the major and minor criteria vary according to the prevalence

A

yes
based on high- risk and low- risk countries.
Sri Lanka is a high- risk country

29
Q

RF

The vegetations are mainly growing on

A

chordae tendinae. firmly attached

30
Q

RF

Ix

A
  • Throat swab and culture
  • ASOT >250 IU
  • Anti DNA ase B elevated, antistreptococcal hyaluronidase test
  • ESR, CRP
  • ECG, Echo, CXR
31
Q

RF

ECG findings

A

Prolonged PR interval

32
Q

RF

Echo, CXR findings

A

may have heart failure

33
Q

RF

in myocarditis what needs to be monitored

A

sleeping pulse rate

34
Q

RF

Mx

A
  • Treat the infection
  • general Mx
35
Q

RF

How to treat the infection

A
  • PO penicillin for 30 days
    OR
  • single dose IM benzathine penicillin
36
Q

RF

General Rx

A
  • Aspirin
  • Bed rest
37
Q

RF

For how long is aspirin given

A

at least 8 weeks

38
Q

RF

aspirin is given for

A

pts with moderate to severe arthritis and carditis without HF. Tapered slowly

39
Q

RF

When is steroids given

A

only preserved for patients in whom salicylates fail

40
Q

RF

Dose of steroids

A

given for severe carditis and CHF.
Prednisone high- dose is given for 2- 3 weeks then tapered over 3 weeks.

41
Q

RF

When is IV steroids given

A

for fulminant cases

42
Q

RF

Chorea Mx

A
  • Phenobarbital
  • Valproic acid
43
Q

RF

Carditis leading to HF Mx

A
  • Diuretics
  • steroids
  • Monitor for arrhythmias
44
Q

RF

Exceptions where aspirin is given for children

A
  • RF
  • Kawasaki
45
Q

RF

Why is aspirin avoided in children

A

Risk of reye syndrome

46
Q

RF

Prophylaxis

A

IM benzathine penicillin 1,2MU 3 weekly

47
Q

RF

Prophylaxis for RF with carditis and clinically significant residual heart disease

A

ABx for a minimum of 10 years after the latest episode.
Prophylaxis is given until the patient is at least 40- 45 years of old and usually continued for life

48
Q

RF

Prophylaxis for RF with carditis and no residual heart disease aside from a mild MR

A

ABx for 10 years or until the pt turns 25 years ( whichever is the longest)

49
Q

RF

Prophylaxis for RF without carditis

A

ABx for 5 years or until the patient aged 18-21 years (whichever is longest)

50
Q

RF

Patient advice

A
  • strict bed rest - avoid HF
  • IM benzathine penicillin to stop recurrent pharyngitis
  • If pharyngitis develops- PO penicillin 10 days
  • Decrease the chances of infection
  • Good oral hygiene
  • serial echos
51
Q

RF

If the patient cannot tolerate penicillin

A

give erythromycin

52
Q

RF

Why is prophylaxis necessary

A

repeated attacks of pharyngitis can cause repeated attacks of carditis which can affect the MV and causing MR

53
Q

RF

Reason for Rx the infection

A

to prevent the spread of MO. it is carried by the nose.

Cardiology (7 decks)

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