Rheumatic Heart Disease

Question 1

What type of condition is Rheumatic fever?

Answer 1

Autoimmune condition

Question 2

What is rheumatic fever triggered by?

Answer 2

Streptococcal pyogenes infection

Question 3

What type of bacteria is streptococcus pyogenes?

Answer 3

Group A beta haemolytic

Question 4

How does rheumatic heart disease occur?

Answer 4

Antibodies created against the streptococcus bacteria that also target tissues in the body

Question 5

What type of condition is rheumatic fever?

Answer 5

Type 2 hypersensitivity disorder

Question 6

When does rheumatic fever typically occur?

Answer 6

2-4 weeks after a streptococcal infection- tonsillitis

Question 7

What is the diagnosis of rheumatic heart disease based on?

Answer 7

Evidence of recent streptococcal infection
2 major criteria or
1 major and 2 minor

Question 8

What are the major criteria used for the diagnosis of rheumatic fever?

Answer 8

erythema marginatum
Sydenham's chorea
polyarthritis
carditis and valvulitis (eg, pancarditis)
subcutaneous nodules

Question 9

What are the minor criteria used for the diagnosis of rheumatic fever?

Answer 9

raised ESR or CRP
pyrexia
arthralgia (not if arthritis a major criteria)
prolonged PR interval

Question 10

How is the skin affected with rheumatic fever?

Answer 10

Subcutaneous nodules

Erythema marginatum rash

Question 11

How is the heart affected in someone with rheumatic fever?

Answer 11

Carditis

Question 12

How does carditis present?

Answer 12

Tachycardia or bradycardia
Murmurs from valvular heart disease, typically mitral valve disease
Pericardial rub on auscultation
Heart failure

Question 13

What are subcutaneous nodules?

Answer 13

Firm painless nodules occur over extensor surfaces of joints, such as the elbows.

Question 14

What is an erythema marginatum rash?

Answer 14

pink rings of varying sizes affecting the torso and proximal limbs.

Question 15

How is the nervous system involved with rheumatic fever?

Answer 15

Sydenham’s Chorea

Question 16

What is Sydenham’s chorea?

Answer 16

Irregular, uncontrolled and rapid movements of the limbs

late sign

Question 17

What pneumonic can be used for the diagnosis of rheumatic fever?

Answer 17

JONES – FEAR.

Question 18

What does JONES stand for? (major criteria)

Answer 18

J – Joint arthritis
O – Organ inflammation, such as carditis
N – Nodules
E – Erythema marginatum rash
S – Sydenham chorea

Question 19

What does FEAR stand for? (minor criteria)

Answer 19

Fever
ECG Changes (prolonged PR interval) without carditis
Arthralgia without arthritis
Raised inflammatory markers (CRP and ESR)

Question 20

What is used in the management of rheumatic fever for the streptococcal infection?

Answer 20

STAT dose of IV benzylpenicillin and Phenoxymethylpenicillin (penicillin V) for 10 days.

Question 21

What is used in the management of rheumatic fever for the joint pain?

Answer 21

NSAIDs (e.g. ibuprofen)

Question 22

What is used in the management of rheumatic fever for the carditis?

Answer 22

Aspirin

Question 23

What are possible complications of rheumatic fever?

Answer 23

Recurrence of rheumatic fever
Valvular heart disease- mitral stenosis
Chronic heart failure

Question 24

What are the main 3 symptoms of rheumatic fever?

Answer 24

Fever
Migratory polyarthritis
Carditis

Question 25

How can carditis present?

Answer 25

Chest pain
Breathlesness
Palpatations

Question 26

How can carditis present?

Answer 26

Chest pain
Breathlesness
Palpatations

Question 27

What would indicate recent streptococcal infection?

Answer 27

Raised or rising streptococci antibodies
Positive throat swab
Positive rapid group A streptococcal antigen test

Question 28

What is the main complication of rheumatic heart disease?

Answer 28

Mitral disease- Mitral stenosis

Question 29

Example

Answer 29

Patient unwell for the last 2 weeks with a sore throat
Now has joint pain and pink rash over body
Jerking movements of face and hands