Rheumatic Fever Flashcards
How do they present?
2-3 weeks after throat infection
- fever
- poor appetite
- weight loss
- fever
- painful joints
- heart failure
Diagnosis
2 major OR 1 major and 2 minor Major - carditis - polyarthritis - syndenham chorea - erythema marginatum - subcutaneous nodules
minor
- increased PR interval on ECG
- arthralgia
- increased CRP, ESR, WBC
- fever
- history of previous RF
Treatment GAS pharyngitis
AND eradicate remaining streptococci
Benzathine penicillin G - < 30kg - 600 000 IU IMI stat
> 30kg - 1,2 mil IU IMI stat
Penicillin V - 50mg/kg/day - 3 doses before meals po 10 days - compliance (4 doses to eradicate)
Secondary prevention - RF prophylaxis
Benzathine penicillin G - < 30kg 600 000 IU IMI
> 30kg 1,2 mil IU IMI
every 3-4 weeks
Penicillin VK 250mg bd PO
Medical Rx CCF
Decrease preload = Diuretics - HCTZ, Furosemide, Spironolactone
Increase contractility and function = Inotropes - Digoxin
IV inotropes - Dopamine, Dobutamine
Decrease the after load = Vasodilators - ACE inhibitors
Control compensatory mechanisms = B blockers - CI in children
Histology
inflammatory cell infiltration and proliferation of plump macrophages - anitschkow cells resulting in formation of Aschoff bodies