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Paediatrics > Rheumatic heart Disease > Flashcards

Rheumatic heart Disease Flashcards

1
Q

In what age groups does acute rheumatic fever occur in?

A

Between ages 5-15

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2
Q

What organism causes acute rheumatic fever?

A

Group A beta-hemolytic streptococci

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3
Q

When do the signs and symptoms occur in acute rheumatic fever?

A

Usually 2-3 weeks after a pharyngeal infection

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4
Q

What are the 5 major JONES criteria we use to diagnose acute rheumatic fever?

A
  1. Carditis
  2. Chorea
  3. Polyarthritis
  4. Subcutaneous nodules
  5. Erythema marginatum
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5
Q

How would we diagnose a patient with rheumatic fever?

A
  1. If there are 2 or more major criteria or if there is 1 major criteria with 2 minor criteria present with the history of a pharyngeal infection
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6
Q

What is chorea?

A

-a neurological disorder characterized by jerky involuntary movements affecting the shoulders, hips and face

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7
Q

What age is most affected by chorea?

A

-girls aged between 7-14 years

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8
Q

How long does it take before the symptoms of chorea start to develop after the streptococcal infection?

A

-weeks to months

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9
Q

How does a child with chorea usually present?

A
  • clumsy and spilling drinks and dropping things
  • they have involuntary grimacing, asymmetrical jerky movements which make writing, tying up shoe laces etc difficult to do
  • they have alternating crying and laughing spells
  • hippus when shining a light in their eye
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10
Q

What is hippus?

A

Hippus is the involuntary relaxation and constriction of the pupil

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11
Q

Where does the erythema marginatum usually occur?

A
  • on the trunk and limbs and never on the face

- characterized by transient, serpentine erythematous rash

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12
Q

How do the subcutaneous nodules usually appear?

A

-They are small, mobile and non tender usually on the extensor surfaces like the elbows, wrists, knuckles and knees

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13
Q

How do we diagnose carditis?

A
  1. Cardiac murmurs
  2. cardiac enlargement
  3. friction rubs
  4. pancarditis
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14
Q

What cardiacs murmurs do we hear at the apex/mitral valve?

A
  • high pitched pansystolic murmur due to mitral valve regurgitation
  • sometimes low pitched mid-diastolic murmur at the apex is also heard but disappears after the acute process
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15
Q

What cardiac murmurs do we hear at the aortic area?

A
  • high pitched early diastolic murmur heard at the aortic area
  • it can be at the left sternal edge when the patient is sitting up and leaning forward
  • if severe a wide pulse pressure + collapsing pulse is present
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16
Q

How do we observe the cardiac enlargement?

A

-we detect it on chest X-ray

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17
Q

What is a friction rub?

A

Also known as a pericardial rub, it is a way to diagnose pericarditis

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18
Q

What is tamponade?

A

Compression of the heart due to fluid accumulation

19
Q

How does a large pericardial effusion present?

A
  • it presents with tamponade
  • distended neck veins
  • hepatomegaly
  • pulsus paradoxus
  • ST elevation on electrocardiogram
  • globular enlargement of cardiac shadows on X-ray
20
Q

What are the 5 minor criteria used to diagnose rheumatic fever?

A
  1. Arthralgia
  2. Prolonged PR interval on ECG >0,18 seconds
  3. Increased CRP/ESR
  4. Previous history of rheumatic fever
  5. Fever >38 degrees
  6. Leucocytosis 12-15 x 10 to the power of 9/l
21
Q

How do we test for streptococcus in a child?

A

-we do throat swabs

22
Q

What is the management of rheumatic fever?

A
  1. Prevention
  2. Penicillin
  3. Rest in bed
  4. Anti-inflammatories for the arthritic pain
23
Q

How do we prevent rheumatic fever?

A

-usually occurs in crowded areas, lack of primary care facilities and poor housing

24
Q

When should we give the patient penicillin?

A

-we should give the patient penicillin a week after the onset of symptoms to try to prevent rheumatic fever from occurring

25
Q

What can we give instead of penicillin?

A

We can give the child erythromycin (125-250mg)

26
Q

What is important pertaining to rest with children?

A

The children must lie still and shouldn’t be allowed to walk until the joints have been treated, the cardiac enlargement decreased and the and the sleep rate pulse diminished

27
Q

What would you give to treat the arthritis?

A

I would start by giving salicylates to alleviate the pain(40-60mg/kg/day) or give aspirin(80-120mg/kg/day)

28
Q

What are the side effects of salicylates?

A
  1. Nausea
  2. Vomiting
  3. Tinnitus
  4. Dizziness
  5. Gastric irritation which can be buffered by milk
29
Q

What do we use to treat the chorea?

A

Haloperidol (0,025mg-0,05mg/kg/day

30
Q

What is chronic heart disease?

A

-heart valve damage caused by rheumatic fever

31
Q

Which valves are usually affected in rheumatic heart disease?

A

-mitral and aortic valves

32
Q

What special investigations would we do in rheumatic heart disease?

A
  1. Chest X-ray
  2. ECG
  3. Electrocardiogram
  4. Full blood count
  5. Electrolytes
33
Q

What occurs more often between mitral regurgitation and mitral stenosis?

A

Mitral regurgitation

34
Q

What type of murmur usually occurs with mitral regurgitation?

A

Pansystolic murmur radiating to the left axilla

35
Q

What happens to the left ventricle in mitral regurgitation?

A
  • left ventricle becomes enlarged and hypertophied

- causes left heart failure and pulmonary oedema

36
Q

What happens if it is severe mitral regurgitation?

A

-displacement of the apex to the left axilla And back which is thrusting in nature

37
Q

What should we consider if there’s a third heart sound before a diastolic murmur?

A

-there is critical overloading of the left ventricle

38
Q

What do the patients with ventricular overloading present with?

A

Poor effort tolerance

  • orthopnea
  • paroxysmal nocturnal dyspnea
39
Q

How would you treat the overloaded left ventricle?

A

Using digoxin

40
Q

How does the mitral stenosis occur?

A

-takes a longer time to develop in children and must be more severe type of rheumatic disease

41
Q

What happens as a result of the mitral stenosis?

A
  1. Increased atrial pressure
  2. Pulmonary arteriolar hypertension
  3. Pulmonary oedema
42
Q

What murmur is associated with mitral stenosis?

A

-diastolic murmur with a tapping apex and opening snap if the valves are mobile

43
Q

What would we find on chest X-ray for mitral stenosis?

A

-enlarged left atrium

Paediatrics (40 decks)

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