Week 3 - Acute Rheumatic Fever and Rheumatic Heart Disease

Question 1

What is Acute rheumatic fever and what causes it

Answer 1

ARF is an acute generalized inflammatory reaction to a systemic Group A Streptococcus infection

Question 2

What are management strategies for Acute Rheumatic Fever

Answer 2

• decrease average number of people living in one home
• Better hygiene standards
• Improved access to penicillin based antibiotics

Question 3

How does acute rheumatic fever occur - what does it do in the body

Answer 3

1. ARF begins when Group A Streptococcus (GAS) penetrate epithelium
2. The body’s immune system responds, producing antibodies - Be cells and T cells to fight the bacteria (GAS)
3. The antibodies mistakenly target the body’s own tissues due to structural similarities between certain streptococcal antigens and human tissues
4. It causes the heart tissue to become inflamed (carditis) This inflammation affects all layers of the heart

Question 4

What areas does acute rheumatic fever affect

Answer 4

• heart (specifically valves)
• brain
• joints
• skin

Question 5

What are the 3 layers of the heart

Answer 5

Layers of the Heart wall from outside to inside

• Pericardium - 2 layers - parietal and visceral layer with pericardial fluid in between
• Myocardium - muscle proper of the heart
• Endocardium - most inner layer in contact with heart blood

Question 6

What is Rheumatic heart disease

Answer 6

results from repeated infection and progressive damage from Acute rheumatic fever. Leading to permanent damage and function impairments.

Question 7

What does Rheumatic heart disease do to the heart

Answer 7

1. Antibodies mistake the endocardium cells as foreign and lead to local areas of damage (mostly the valves)
2. Causes valves to calcify and become stiff - forming holes between the valves as they can’t close properly
3. Unfunctional valves cause blood to leak into atria - inhibiting ventricle pressure from increasing
4. Causes drop in stroke volume and cardiac output
5. Vegetations form

Question 8

What are the impacts of RHD on blood flow

Answer 8

decreases less blood to be ejected during ventricle contraction and less blood filling the ventricles
- Decrease in stroke volume (blood pumped out per beat)
- Drop in cardiac Output (amount of blood pumped into the aorta per min)

Question 9

What is regurgitation

Answer 9

when blood flows back into a part of the heart which is wasn’t suppose to

Question 10

What is vegetations

Answer 10

Local areas of fibrous inflammatory cells and bacteria which form on the valves due to rheumatic heart disease. These areas cause scarring making the valves even more rigid.
Inhibiting the valves from opening or closing properly
Hence further decreasing stroke volume and cardiac output.

Question 11

What are the complication of rheumatic heart disease

Answer 11

• Vegetation nodules can lead to more bacterial infections –> endocarditis
• Blood build up in atria causing atria to overstretch and cause atrial fibrillation
• Atrial fibrillation can cause blood clots - increase risk of stroke
• Increase the workload of the heart -> heart failure

Question 12

What are the names of the 4 levels of prevention for ARH and RHD

Answer 12

• primordial
• primary
• secondary
• tertiary

Question 13

What is a primordial prevention of ARH and RHD

Answer 13

Change environmental factors to prevent ARH from occurring e.g. stop GAS infections by improving factors of living

Question 14

What are primary preventions of ARF and RHD

Answer 14

When ARH is detected and trying to prevent an auto immune response early e.g. Stop infection from becoming ARF through antibiotics

Question 15

What are secondary preventions of ARF and RHD

Answer 15

to prevent repeat ARF infections, through long term injection of benzathine penicillin

Question 16

What are tertiary preventions of ARF and RHD

Answer 16

treatment of RHD through valve replacement, and management of heart failure