Rheumatic Heart Disease

Question 1

What is rheumatic fever?

Answer 1

Inflammatory changes in the heart and joints, sometimes also with neurological symptoms

Question 2

Where is rheumatic fever still common?

Answer 2

India, Middle East and Central Africa

Question 3

Who does rheumatic fever commonly effect?

Answer 3

Children aged 5-15yrs (boys>girls)

Question 4

What are the presenting features of rheumatic fever?

Answer 4

‘Flitting (painful) polyarthritis of large joints (wrists, elbows, knees and ankles), skin rashes and fever

Question 5

What features are likely to be present in the acute phase?

Answer 5

Pancarditis (inflammation affecting the endocardium, myocardium and pericardium) ad heart murmurs

Question 6

Why do those with rheumatic fever end up with damage to the heart tissue?

Answer 6

Most patients have had a recent sore throat usually due to group a strep which causes a strong antibody reaction which may cross react with unknown antigens in the connective tissue

Question 7

Where do the valvular heart diseases originate from?

Answer 7

Either from valvular stenosis, valvular incompetency or vegetations

Question 8

What can pancarditis caused by rheumatic fever progress to?

Answer 8

Chronic rheumatic heart disease

Question 9

What does inflammation of the endocardium and left sided valves cause?

Answer 9

Fibrinoid necrosis of the valve cusps/chordae tendineae over which small vegetations form

Question 10

What does rheumatic heart disease cause?

Answer 10

Mitral stenosis. It can also cause mitral regurgitation, aortic stenosis and aortic regurgitation/incompetence