6a. Rheumatic Fever Flashcards
LOs
What is rheumatic fever?
- Rheumatic fever is a multisystem disease which occurs after a group A streptococcal infection
- Affects heart, skin, joints and central nervous system
Incidence and Epidemiology of Rheumatic Fever
Aetiopathogenesis of rheumatic fever
Rheumatic fever aetiopathogenesis as a result of the inflammatory response?
• 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
How is a diagnosis made for rheumatic fever?
What is polyarthritis
- 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
what is carditis?
- 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
carditis patient presentations?
- 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.
types of carditis?
- pericarditis
- myocarditis
3.endocarditis
what is pericarditis? Presentation?
- 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
what is a pericardium
sac in which the heart sits
what is myocarditis? presentation?
- 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
what is a myocardium?
muscle of the heart
what is endocarditis?
• 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
what is chorea?
•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
what are subcutaneous nodules?
- Rare
- Small (up to 0.5cm), non-tender, mobile, firm
- Occur over bony prominence e.g. elbow
what are Erythema nodosum?
- Larger than subcutaneous nodules
- Painful
- Deep pink/red nodules are tender on palpation
what is Erythema Marginatum?
- 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
