Rheumatic Heart Disease

Question 1

What must you have in order to get rheumatic heart disease?

Answer 1

Rheumatic fever

Question 2

Who does rheumatic fever usually occur in?

Answer 2

Children ages 5-15 yrs

Question 3

To get rheumatic fever, a child must…?

Answer 3

• develop strep throat

- have a genetic predisposition for developing RF (complex trait ethology. Only about 3% of children have it)

Question 4

Strep throat?

Answer 4

An infection in the pharynx

Question 5

How is strep throat eradicated normally?

Answer 5

T cells and antibodies form and the infection is eradicated by defense cells.

Question 6

If a child is pre-disposed to molecular mimicry, how is strep throat eradicated?

Answer 6

Antibodies detect the epitope on the antigen and if the epitope on the bacteria is similar to the one our self-antigen, then the antibodies get confused and begin destroying our own cells. The antibodies and the self-antigen form an immune complex that activates the complement system (causing inflammation and tissue damage). These antibodies that were originally formed to fight against the microbe, will continue to target antigens even after the infection is eradicated.

Question 7

What kind of effects does rheumatic fever have?

Answer 7

Systemic effects (antibodies target antigens in the heart, joints, CNS, integument)

Question 8

What causes the systemic effects in RF?

Answer 8

The autoimmunity

Question 9

Rheumatic heart disease?

Answer 9

Inflammation of valves, myocardium and pericardium

Question 10

What are the 2 forms of RHD?

Answer 10

Acute & chronic RHD

Question 11

What is special about acute RHD?

Answer 11

It is self-limiting (meaning it will heal on its own)

** HOWEVER -> RHD must still be monitored and symptoms must be treated as they rise **

Question 12

What occurs with chronic RHD?

Answer 12

It will lead to severe heart damage

Question 13

Manifestations of RHD?

Answer 13

• general cold or cough symptoms

- valvular dysfunction resulting in SOBOE, weakness, fatigue, edema, chest pain

Question 14

Diagnostics of RHD?

Answer 14

• Diagnose strep throat first (throat swab) [however, this infection may have cleared up by the time RHD symptoms arise]
• Non-specific tests: CBC, differential, CRP, ESR

Question 15

Treatment for RHD?

Answer 15

• prompt diagnosis and treatment of strep throat
• antibiotics and anti-inflammatories
• bed rest is key to recovery (5-6 weeks) to decrease workload.
• symptomatic management -> handle cardiac complications as they arise

Question 16

Why is best rest key to recovery in RHD?

Answer 16

to decrease workload of heart