Rheumatic Fever and Bacterial Endocarditis Flashcards
_____ is an inflammatory, immune process that develops as sequelae from untreated or inadequately treated streptococcal pharynx infection (i.e. strep throat)
Rheumatic fever
What causes Rheumatic Fever?
Caused by Group A beta-hemolytic streptococcal infection (GAS)
Rheumatic Fever Epidemiology
● Peak incidence is between ages 5-15 years
● More common in underdeveloped countries
● responsible for 275,000 deaths in young
people worldwide each year
Pathophysiology of Rheumatic Fever
There is a latent period of 2-3 weeks between GAS infection and the start of rheumatic fever symptoms
Rheumatic Fever Diagnosis - Jones Criteria
Diagnosis: 2 major criteria or 1 major + 2 minor criteria
MAJOR CRITERIA
1. Polyarthritis
2. Erythema Marginatum
3. Carditis
4. Subcutaneous Nodules
5. Sydenham Chorea
MINOR CRITERIA
1. Clinical findings
a. Fever
b. Polyarthralgias
2. Lab Findings:
a. ↑ ESR
b. ↑ CRP
c. Prolongation of the PR interval
Usually the 1st symptom that develops for Rheumatic fever
Polyarthritis
Polyarthritis
● Usually the 1st symptom
● More common and severe in teenagers and young adults
● Affects several joints in quick succession, seems to migrate
○ Knees, ankles, elbows, wrists
● Responds well to anti inflammatory medication
● No lasting damage or deformity
T/F there is no lasting damage or deformity with polyarthritis
T
Erythema marginatum
● Rapidly enlarging maculopapular lesions that assume the shape ofrings or crescents with CENTRAL CLEARING.
● Can be raised, confluent and either transient or persistent.
● Blanches w/ pressure, not itchy or painful
Part of the JONES criteria
_____: Inflammation of the myocardium, pericardium, endocardium, and/or valves
Carditis
● Mitral or Aortic murmurs
● Pericarditis
● Cardiomegaly
● Heart failure
Part of the JONES criteria
Subcutaneous Nodules are typically
Small (2 cm or less in diameter), firm,
and nontender
Attached to fascia or tendon sheaths
over bony prominences
Part of JONES criteria
● Small (2 cm or less in diameter), firm,
and nontender.
● Attached to fascia or tendon sheaths
over bony prominences.
○ Elbow most common
● Persist for days or weeks, recurrent
● Smaller and shorter-lived than RA
nodules
Describes what
Subcutaneous Nodules
LEAST COMMON but MOST diagnostic manifestation of acute rheumatic fever
Syndeham Chorea
Describe Syndeham Chorea
Neurologic disorder consisting of
abrupt, nonrhythmic, involuntary
movements, muscular weakness, and
emotional disturbances.
LEAST COMMON finding (3% of cases)
● LONG latent period, 1-8 months after
GAS infection
● Sometimes the only symptom
● More common in girls
_____ is the MAJOR complication of Rheumatic Fever
Rheumatic heart disease
Complications of Rheumatic Fever
- Rheumatic heart disease is the MAJOR complication
- Arrhythmias
- Pneumonitis
- Pericarditis with pericardial effusion
- Heart Failure (severe cases)
Excess fluid between the heart and the pericardium, Can turn into Cardiac Tamponade is called what
Pericardial Effusion