Rheumatic heart disease

Question 1

what is rheumatism?

Answer 1

inflammation of joints, muscles, fibrous tissue

Question 2

what is rheumatic fever?

Answer 2

a type of inflammatory disease that can damage the heart tissue -> rheumatic heart disease

Question 3

after which disease does rheumatic heart disease develop?

Answer 3

streptococcal pharyngitis

Question 4

what is streptococcal pharyngitis? which pathogen is involved?

Answer 4

inflammation of the throat due to streptococcus pyogenes

Question 5

what is streptococcal pharyngitis sometimes shortly referred to? (in US)

Answer 5

‘strep throat’

Question 6

which group of bacteria is streptococcus pyogenes part of? (or referred to as)

Answer 6

group a beta hemolytic streptococcus

Question 7

group a beta hemolytic streptococcus: which enzyme do they produce? what is the consequence?

Answer 7

streptolysin -> can lyse RBCs (= beta hemolysis)

Question 8

what is an important protein on top of the streptococcus pyogenes bacteria? what is the effect?

Answer 8

M-protein -> induces immune reaction and ab production

Question 9

antibodies against M-protein can cross-react against which cells?

Answer 9

heart, joint, skin and brain cells –> inflammation and destruction

(=rheumatic fever)

Question 10

is rheumatic fever a hypersensitivity reaction?

Answer 10

yes, type II

Question 11

which percentage of people with strep throat gets rheumatic fever?

Answer 11

3%

Question 12

who are more likely to develop rheumatic fever?

Answer 12

children
people in areas with poverty & crowding

Question 13

which 4 organs can be involved in rheumatic fever?

Answer 13

joints
heart
skin
brain

Question 14

what is the most common clinical finding of rheumatic fever?

Answer 14

migratory polyarthritis: multiple large joints become inflamed one after another

Question 15

is damage of migratory polyarthritis permanent?

Answer 15

no

Question 16

what can happen to the heart in acute rheumatic fever?

Answer 16

pancarditis
- endocarditis: inner lining, including the valves (mitral and aortal)
- myocarditis: muscle (aschoff bodies with areas of necrosis & immune cells)
- pericarditis

Question 17

which heart valve is most commonly infected in rheumatic fever? which second?

Answer 17

1. mitral valve
2. aortic valve also

Question 18

what is the most common cause of death of rheumatic fever? why is this?

Answer 18

myocarditis, because the heart can’t contract -> heart failure

Question 19

is pericarditis painful?

Answer 19

yes

Question 20

can you hear pericarditis with a stethoscope?

Answer 20

yes, you can hear friction

Question 21

what can you see on the skin in rheumatic fever? (2 things)

Answer 21

subcutaneous nodules (collagen lumps)

erythema marginatum (rings)

Question 22

which neurological symptoms can be present in rheumatic fever?

Answer 22

sydenham chorea: rapid movements in face & arms, later in disease

Question 23

what is the cause of sydenham chorea?

Answer 23

damage of basal ganglia

Question 24

what are the jones criteria?

Answer 24

migratory polyarthritis
carditis
skin nodules
erythema marginatum
sydenham chorea
+ pos test for strep throat

Question 25

how long after strep throat do symptoms of rheumatic fever start?

Answer 25

2-3 weeks

Question 26

what are minor criteria for rheumatic fever?

Answer 26

fever, joint paint
ECG changes
leukocytosis
increased CRP, ESR

Question 27

how does acute rheumatic fever resolve? (3 things)

Answer 27

rest
anti-inflammatory medication
antibiotics (such as penicillin to wipe out any leftover streps in throat)

Question 28

what can develop when the body is repeatedly exposed to streptococcus pyogenes?

Answer 28

chronic rheumatic heart disease

Question 29

what happens to the valves in chronic rheumatic heart disease?

Answer 29

fibrous tissue on mitral valves, valves can fuse together

Question 30

name 2 consequences of fibrous scar tissue on valves in chronic rheumatic heart disease?

Answer 30

• regurgitation (valves don’t close all the way) -> can progress to stenosis (narrowed opening)
• infective endocarditis: microbial attachment and invasion

Question 31

how can you prevent chronic rheumatic fever?

Answer 31

reducing strep throat infections, e.g. by prolonged antibiotics (10 yrs - life)