Rheumatic Heart Disease Flashcards
What type of condition is Rheumatic fever?
Autoimmune condition
What is rheumatic fever triggered by?
Streptococcal pyogenes infection
What type of bacteria is streptococcus pyogenes?
Group A beta haemolytic
How does rheumatic heart disease occur?
Antibodies created against the streptococcus bacteria that also target tissues in the body
What type of condition is rheumatic fever?
Type 2 hypersensitivity disorder
When does rheumatic fever typically occur?
2-4 weeks after a streptococcal infection- tonsillitis
What is the diagnosis of rheumatic heart disease based on?
Evidence of recent streptococcal infection
2 major criteria or
1 major and 2 minor
What are the major criteria used for the diagnosis of rheumatic fever?
erythema marginatum Sydenham's chorea polyarthritis carditis and valvulitis (eg, pancarditis) subcutaneous nodules
What are the minor criteria used for the diagnosis of rheumatic fever?
raised ESR or CRP
pyrexia
arthralgia (not if arthritis a major criteria)
prolonged PR interval
How is the skin affected with rheumatic fever?
Subcutaneous nodules
Erythema marginatum rash
How is the heart affected in someone with rheumatic fever?
Carditis
How does carditis present?
Tachycardia or bradycardia
Murmurs from valvular heart disease, typically mitral valve disease
Pericardial rub on auscultation
Heart failure
What are subcutaneous nodules?
Firm painless nodules occur over extensor surfaces of joints, such as the elbows.
What is an erythema marginatum rash?
pink rings of varying sizes affecting the torso and proximal limbs.
How is the nervous system involved with rheumatic fever?
Sydenham’s Chorea
What is Sydenham’s chorea?
Irregular, uncontrolled and rapid movements of the limbs
late sign
What pneumonic can be used for the diagnosis of rheumatic fever?
JONES – FEAR.
What does JONES stand for? (major criteria)
J – Joint arthritis O – Organ inflammation, such as carditis N – Nodules E – Erythema marginatum rash S – Sydenham chorea
What does FEAR stand for? (minor criteria)
Fever
ECG Changes (prolonged PR interval) without carditis
Arthralgia without arthritis
Raised inflammatory markers (CRP and ESR)
What is used in the management of rheumatic fever for the streptococcal infection?
STAT dose of IV benzylpenicillin and Phenoxymethylpenicillin (penicillin V) for 10 days.
What is used in the management of rheumatic fever for the joint pain?
NSAIDs (e.g. ibuprofen)
What is used in the management of rheumatic fever for the carditis?
Aspirin
What are possible complications of rheumatic fever?
Recurrence of rheumatic fever
Valvular heart disease- mitral stenosis
Chronic heart failure
What are the main 3 symptoms of rheumatic fever?
Fever
Migratory polyarthritis
Carditis
How can carditis present?
Chest pain
Breathlesness
Palpatations
How can carditis present?
Chest pain
Breathlesness
Palpatations
What would indicate recent streptococcal infection?
Raised or rising streptococci antibodies
Positive throat swab
Positive rapid group A streptococcal antigen test
What is the main complication of rheumatic heart disease?
Mitral disease- Mitral stenosis
Example
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
