Rheumatic Heart Disease

Question 1

Definition

Answer 1

A sequela of pharyngeal streptococcal infection caused by Group A, Beta-hemalytic S. pyogenes pharyngitis

An autoimmune disease caused by cross-reactions between Strep antigens and the antigens on joint and heart tissue

Rheumatic fever is a systemic immune process may or may not lead to RHD

RHD is a valvular abnormality secondary to rheumatic fever most often manifesting as mitral stenosis

Question 2

Symptoms

Answer 2

Presents 1-2 weeks after a Group A Strep infection (usually pharyngitis)
with any combination of a variety of symptoms that together lead to diagnosis

Question 3

Jones Criteria

Answer 3

Used to diagnose RHD
Evidence of a preceding group A streptococcal infection plus two major critertia or one major and two minor criteria

Question 4

Major Criteria

Answer 4

Migratory polyarthritis
Carditis (myocarditis, pericarditis)
Erythema marginatum
Subcutaneous nodules
Chorea

Question 5

Minor Criteria

Answer 5

Fever
Antecedent strep infection
Arthralgias
Elevated ESR
Prolonged PR internal

Question 6

Evaluation
Labs

Answer 6

Positive rapid antigen testing
Positive ASO and/or DNAase B
Elevated ESR

Question 7

Evaluation
Imaging

Answer 7

Doppler echocardiography may demonstrate valvular insufficiency or ventricular dysfunction

Heart catheterization only indicated in cases of chronic disease to evaluate mitral and aortic valves and potentially balloon stenosed valves

EKG
Sinus tachycardia in most cases may demonstrate sinus bradycardia in patients with decreased vagal tone can show varying degrees of heart block depending on severity of case

Question 8

Differential

Answer 8

RA, SLE, endocarditis, osteomyelitis, Lyme’s Disease, Sickle cell disease, any variety of
isolated valvular disorders

Question 9

Treatment

Answer 9

Penicillin V indicated for treatment of acute rheumatic fever

Clindamycin indicated for chronic carriers of GABHS

Salicylates for fever

Question 10

Prognosis, Prevention, and Complications

Answer 10

Prognosis is good if treated acutely

Prophylaxis against further streptococcal infection:
No evidence of carditis: 5 years or until age 21 (whichever is longer)
Evidence of carditis without valvular abnormalities: 10 years or until age 21 (whichever is longer)
Evidence of carditis and valvular abnormalities: 10 years or until age 40 (whichever is longer)

Complications depend on severity of disease can range from none to complete heart block