Rheumatic fever

Question 1

Physiology

Answer 1

1. URI of Group A Beta-hemolytic streptococcus
2. 2 weeks after: delayed, systemic, immune mediated
   Cross reacts with CT of heart & other organs

Question 2

Acute Rheumatic fever epidemiology

Answer 2

1. Primarily children (9-11 y.o.)
2. Epidemic during first half of 20th century
3. Now: better due to socioeconomic & ABX
4. Leading cause of heart ds in 5-25 y.o.

Question 3

Antigen/Antibody

Answer 3

Antigens= Streptococcal antigen O

Antibodies= Antistreptolysin O (ASO)

Question 4

Patho of RHD

Answer 4

Sterile, non-bacterial

Inflammatory lesions & granuloas

Question 5

Heart pathology of RHD

Answer 5

Pancarditis (All 3 layers) Peri, Myo & Endo

Question 6

RHD Pericarditis

Answer 6

Fibrin, Bread and butter.
May progress to adhesive–restrictive
Clinically: friction rub

Question 7

RHD Myocarditis

Answer 7

Aschoff Bodies: lymphocytes & macrophages surrounding central fibrinoid necrosis
With time, granuloma–scar
Majority of deaths=fatal arrhythmias

Question 8

RHD Endocarditis

Answer 8

Most prominent change=valvulitis
Inflammation--Ulceration
Covered with fibrin thrombi
Sterile vegetation along lines of closure
Insufficiency--Stenosis

Question 9

RHD Fish mouth stenosis

Answer 9

Fibrin across the commissures of valve
Chordae tendinae of MV shorten/thicken
Fuse to one another

Question 10

MV Insuff result

Answer 10

LA will dilate

Question 11

AV Insuff result

Answer 11

LVH & dilation

Question 12

MV stenosis result

Answer 12

1. Stagnation–clot

2. Pressure back up–Cor Pulmonale (RHF)

Question 13

AV stenosis result

Answer 13

LVH–LHF–Cor Pulmonale

Question 14

Cause of most deaths after acute phase

Answer 14

Endocarditis/Valvulitis

Question 15

Jones Criteria Major

Answer 15

1. Carditis
2. Arthritis
3. Nodules
4. Chorea
5. Erythema Marginatum

Question 16

Polyarthritis characteristics

Answer 16

Migratory, 1-4 weeks then subsides w/o deformity

Question 17

Nodules characteristics

Answer 17

Subcutaneous, most common in children.
Location: over extensor tendons of extremities–Knees, ankles, wrists, elbows
Firm, nontender & recurrent

Question 18

Sydenhams chorea characteristics

Answer 18

Involuntary, continuous, non-repetitive, jerky.

Impairs speech & gait

Question 19

Erythema Marginatum characteristics

Answer 19

Maculopapular, migratory, no scars.
Location: Trunk & proximal extremities
Spares face

Question 20

Lab findings

Answer 20

1. Throat culture negative
2. ASO increasing
3. CRP, ESR, Leukocytosis

Question 21

Minor criteria

Answer 21

1. Hx rheumatic fever
2. Fever
3. Arthralgias
4. EKG evidence
5. Prior strept infection (ASO, CRP, ESR)

Question 22

Criteria needed

Answer 22

2 Major OR

1 Major + 2 Minor

Question 23

Complications

Answer 23

1. MC= Secondary bacterial IE

2. Emboli from vegetation–kidney/brain/extremity infarct

Question 24

Tx/Prevention

Answer 24

1. No cure
2. Lesion: need surgery
3. Valvulitis: replace with artificial valve
4. Prevention: prompt ABX for strept pharyngitis