Rheumatic Heart Disease Flashcards
What is acute rheumatic fever
Acute rheumatic fever (ARF) is an autoimmune inflammatory condition that develops as a sequela of infection of the pharynx by group A beta hemolytic Streptococcus (GABHS). It is noninfectious, non-suppurative sequalae of sore throat, typically begins 2-4 weeks after a streptococcal infection
What are some RFs of ARF
Age : 5-15
Untreated streptococcal infection
Familiar predisposition
Overcrowding (eg. schools, daycare centers)
Poverty, poor hygiene (low socioeconomic status)
Lack of access to medical care
What is the pathophysiology of ARF
Body produce antibodies against streptococci. These antibodies cross react with human tissues because of the antigenic similarity between streptococcal components and human connective tissues (molecular mimicry) Ithere is certain
amino acid sequence that is similar btw GAS and human tissue
What are the symptoms of ARF
Carditis causing heart failure so they may present with symptoms of heart failure
Arthritis (large joints like the knee, the elbow, and wrist)
Erythema marginatum (Skin rash)
Subcutaneous nodules
Sydenham’s chorea
Others: Fever, Sore throat, Abdominal pain, Arthralgia
What are the signs of ARF
Murmurs
Cardiomegaly
Pericardial rub, Pericardial effusion (pericarditis)
Signs of HF
Subcutaneous nodules ( found over the elbow, knees, wrists, ankles back of scalp, spinous processes)
What is the most common and early manifestation of ARF
Arthritis
What is arthritis
Acute painful asymmetric and migratory inflammation of the large joints. Typically affects the knees, ankles, elbows and wrists
Late neurological manifestation
Appears at least 3 months after the
episode of ARF
All the other signs may have
disappeared
Occurs in up to 1/3rd of cases and is
more common in females
Emotional breakdown or changes may
be the first feature
Typically followed by purposeless involuntary choreiform movements of
the face, hand or foot
Speech may be exploding or halting
What is being referred to here
Sydenham’s chorea (St Vitus dance)
What is the name given to the diagnostic criteria for rheumatic fever
Duckett-Jones diagnostic criteria
What are the major criteria for diagnosing ARF
Carditis
Arthritis
Subcutaneous nodules
Erythema marginatum
Sydenham’s chorea
Mnemonic: CASES
What are the minor criteria for diagnosing ARF
Fever
Raised ESR/CRP
Arthralgia
Prolonged PR interval
Previous RF
Mnemonic: FRAPP
How do conclude that someone has ARF in the Duckett-Jones diagnostic criteria
There must be evidence of streptococcal infection plus:
2 major or 1 major + 2 minor
What are some complications of ARF
Valvular heart disease
Arrhythmia (commonly atrial fibrillation)
Congestive heart failure
Infective endocarditis
Pulmonary or systemic emboli
Recurrent infections
What is an RHD
Rheumatic heart disease is a systemic immune process that is sequelae to a beta-hemolytic streptococcal infection of the pharynx
Rheumatic heart disease is permanent heart valve damage results from either a single or repeated attacks of rheumatic fever that lead to deformity and rigidity of valve cusps, the fusion of the commissures, or shortening and fusion of the chordae tendineae.
•It is thought that 40..50% of patients with ARF will go on to developing RHD
Does early valvular damage from RHD cause regurgitation or stenosis
Regurgitation
Over ensuing years, usually as a result of recurrent episodes leaflet thickening, scarring and calcifications stenosis may also develop. People with RHD are often asymptomatic for many years before the valvular heart disease progresses to heart failure
