6a. Rheumatic Fever Flashcards

1
Q

LOs

A
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2
Q

What is rheumatic fever?

A
  • Rheumatic fever is a multisystem disease which occurs after a group A streptococcal infection
  • Affects heart, skin, joints and central nervous system
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3
Q

Incidence and Epidemiology of Rheumatic Fever

A
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4
Q

Aetiopathogenesis of rheumatic fever

A
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5
Q

Rheumatic fever aetiopathogenesis as a result of the inflammatory response?

A

• Vasculitis
↳ inflammation of blood vessels affecting the connective tissue

• Aschoff’s body
↳ Nodules found in the heart of individuals w/ rheumatic fever due to inflamm process
↳ consists of an aggregate of large cells with polymorphs and basophils around a vascular fibrinoid core

• Pancarditis
↳ with the endocardium being the most severely involved

• Chronic rheumatic fever
↳ may develop in 50% of patients with acute rheumatic fever
• 1% mortality in patients’ with carditis

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6
Q

How is a diagnosis made for rheumatic fever?

A
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7
Q

What is polyarthritis

A
  • Most common feature
  • may be first clinical manifestation after the streptococcal sore throat
  • affects 80-90% of patients
  • Lasts 4-6 weeks: sudden onset and will move
    around different joints
  • Accompanied by swelling
  • mainly affects Large joints - knee, ankle, elbow, hip and shoulder
  • pain may last week in any joint
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8
Q

what is carditis?

A
  • broad term for inflammation of heart
  • 40-50% of rheumatic fever patients
  • lasts 3-6 months
  • Occurs roughly 2 weeks after
    polyarthritis, involves all cardiac tissue
  • May be asymptomatic or may
    be present with congestive
    cardiac failure
  • asymptomatic usu only recognised after presentation of other clinical signs or cardiomegaly on chest x-ray
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9
Q

carditis patient presentations?

A
  • Increasing breathlessness - Palpitations - Chest pains
  • Carditis can be associated with congestive cardiac failure ->
    chronic progressive condition that
    affects the pumping power of your heart muscles.
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10
Q

types of carditis?

A
  1. pericarditis
  2. myocarditis
    3.endocarditis
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11
Q

what is pericarditis? Presentation?

A
  • Inflammation of the cardiac
    pericardium
  • occurs in 5-10% of cases
  • one of the major manifestations of acute rheumatic fever
  • Presents with fluid in the
    pericardial space and may give
    rise to an intermittent pericardial
    rub
  • can be heard using a stethoscope
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12
Q

what is a pericardium

A

sac in which the heart sits

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13
Q

what is myocarditis? presentation?

A
  • Involves the myocardium
  • All of the myocardium may be
    involved but the symptoms are a
    result of the left and right ventricular involvement
  • Patients’ present with left
    ventricular failure which may
    lead to right ventricular failure
    and subsequent congestive
    cardiac failure
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14
Q

what is a myocardium?

A

muscle of the heart

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15
Q

what is endocarditis?

A

• inflammation of the endocardium

• The mitral valve is most commonly
affected. It may occur alone or in
association with the aortic valve failure

• When mitral and aortic valve disease
occurs together the disease becomes
‘fulminant’ and is associated with a high
mortality rate

• subsequent Valvulitis results in nodules on the mitral
and aortic valves result in murmurs

• Mitral valve nodule -> carey coombs murmur -> soft diastolic murmur

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16
Q

what is an endocardium?

A

lining of the heart and the valves

17
Q

what is chorea?

A

•Late clinical manifestation
• May occur 4 to 6 months after
the other features of rheumatic
fever
• Sydenham’s Chorea (St Vitus’ Dance) consists of
involuntary movements of the
face and limbs but disappears
during sleep

• Occurs in 10% of patients

18
Q

what are subcutaneous nodules?

A
  • Rare
  • Small (up to 0.5cm), non-tender, mobile, firm
  • Occur over bony prominence e.g. elbow
19
Q

what are Erythema nodosum?

A
  • Larger than subcutaneous nodules
  • Painful
  • Deep pink/red nodules are tender on palpation
20
Q

what is Erythema Marginatum?

A
  • Occurs in 65% of patients
  • Always seen in association with carditis
  • Painless and non-pruritic (not itchy)
  • Serpiginous edge - not well demarcated (wavy) ; fading centre ->
    spreads over the trunk and limbs
21
Q

rheumatic fever summary

A
  • Rheumatic fever is a multisystem disease which occurs after a group A streptococcal infection
  • Affects heart, skin, joints and central nervous system
  • Diagnosis is made using Duckett-Jones Criteria