Rheumatic heart Disease Flashcards
In what age groups does acute rheumatic fever occur in?
Between ages 5-15
What organism causes acute rheumatic fever?
Group A beta-hemolytic streptococci
When do the signs and symptoms occur in acute rheumatic fever?
Usually 2-3 weeks after a pharyngeal infection
What are the 5 major JONES criteria we use to diagnose acute rheumatic fever?
- Carditis
- Chorea
- Polyarthritis
- Subcutaneous nodules
- Erythema marginatum
How would we diagnose a patient with rheumatic fever?
- 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
What is chorea?
-a neurological disorder characterized by jerky involuntary movements affecting the shoulders, hips and face
What age is most affected by chorea?
-girls aged between 7-14 years
How long does it take before the symptoms of chorea start to develop after the streptococcal infection?
-weeks to months
How does a child with chorea usually present?
- 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
What is hippus?
Hippus is the involuntary relaxation and constriction of the pupil
Where does the erythema marginatum usually occur?
- on the trunk and limbs and never on the face
- characterized by transient, serpentine erythematous rash
How do the subcutaneous nodules usually appear?
-They are small, mobile and non tender usually on the extensor surfaces like the elbows, wrists, knuckles and knees
How do we diagnose carditis?
- Cardiac murmurs
- cardiac enlargement
- friction rubs
- pancarditis
What cardiacs murmurs do we hear at the apex/mitral valve?
- 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
What cardiac murmurs do we hear at the aortic area?
- 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
How do we observe the cardiac enlargement?
-we detect it on chest X-ray
What is a friction rub?
Also known as a pericardial rub, it is a way to diagnose pericarditis
What is tamponade?
Compression of the heart due to fluid accumulation
How does a large pericardial effusion present?
- it presents with tamponade
- distended neck veins
- hepatomegaly
- pulsus paradoxus
- ST elevation on electrocardiogram
- globular enlargement of cardiac shadows on X-ray
What are the 5 minor criteria used to diagnose rheumatic fever?
- Arthralgia
- Prolonged PR interval on ECG >0,18 seconds
- Increased CRP/ESR
- Previous history of rheumatic fever
- Fever >38 degrees
- Leucocytosis 12-15 x 10 to the power of 9/l
How do we test for streptococcus in a child?
-we do throat swabs
What is the management of rheumatic fever?
- Prevention
- Penicillin
- Rest in bed
- Anti-inflammatories for the arthritic pain
How do we prevent rheumatic fever?
-usually occurs in crowded areas, lack of primary care facilities and poor housing
When should we give the patient penicillin?
-we should give the patient penicillin a week after the onset of symptoms to try to prevent rheumatic fever from occurring
