Extra cardiac path (infectious endocarditis, rheumatic fever)

Question 1

Define rheumatic fever

Answer 1

An inflammatory (T2HS) multisystem disorder that arises as a delayed complication of an URTI with beta haemolytic streptococci

Question 2

What is the aetiology of rheumatic fever

Answer 2

Pharyngeal infection with Lancefield group A beta-haemolytic streptococci triggers rheumatic fever 2-4 weeks later
Pharyngeal infection with Lancefield group A beta-haemolytic streptococci triggers rheumatic fever 2-4weeks later

Question 3

What criteria is used to diagnose rheumatic fever

Answer 3

Jones
2 major OR 1 major + 2 minor

Question 4

What is the Jones criteria for rheumatic fever

Answer 4

Major:
Carditis
Arthritis
Sydenham’s chorea
Erythema migracans
Subcutaneous nodules

Fever
Raised ESR
Arthralgia
Prolonged PR
Previous rheumatic fever

Question 5

What is the management for rheumatic fever

Answer 5

1. Admit
2. A-E assessment
3. Abx
4. long-term Abx - benzylpenicillin every 4 weeks until 21yo

Question 6

What will be seen on histology for rheumatic fever

Answer 6

Aschoft bodies (small giant cell granulomas)
Antischkov myocytes (regenerating myocytes)

Question 7

What are the types of endocarditis and what will be seen for each

Answer 7

Rheumatic heart disease: WARTY vegetations on valve leaflet
Infective endocarditis: large irregular masses on valve cusps, extends to the chordae tendinae
Non-bacterial thrombotic endocarditis: small, bland vegetation (throbmosis)
Libman sacks: small. sterile, platelet, rich vegetation

Question 8

What are the causes of infective endocarditis

Answer 8

Dental: strep. viridans
IVDU: staph. aureus (usually causes R-sided IE)
Prosthetic: staph. epidermidis
Farmers: coxiella
Unpasteurised: Brucella

Question 9

What are the signs and symptoms of infective endocarditis

Answer 9

Hands: Janeway lesions, osler’s nodes, splinter haemorrhages
Eyes: Roth spots
Haematuria (glomerular nephritis)
Splenomegaly
New onset fever
FLAWS symptoms

Question 10

What criteria is used to diagnose infective endocarditis

Answer 10

Duke’s
2 major
1 major + 3 minor
5 minor

Question 11

What is the Duke’s criteria for diagnosing infective endocarditis

Answer 11

Major
+ve culture for the typical organisms
2 +ve cultures 24h apart
Vegetations seen on echo
New-onset murmur

Minor
RFs of IE
S/S of IE
+ve blood culture that does not fit major criteria
Fever

Question 12

What is the management for infective endocarditis

Answer 12

Abx for 6 weeks
Acute: flucloxacillin
Subacute: benzylpenicillin + gentamicin