Rheumatic Fever
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Created by:
sunshinemedic13 on November 21, 2011
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33 terms
Terms | Definitions |
|---|---|
 Acute Rheumatic fever | delayed sequelae of group A streptococcal pharyngitis, including pharyngitis associated with scarlet fever. |
| Fever • Joint aches • Abdominal pain • Weakness • Fatigue | Non specific symptoms |
| Specific symptoms of Rheumatic fever | • Arthritis that affects numerous joints but emerges in on joint at a time • Abnormal heart beat • Chest Pain • Red patches on skin • Small painless lumps beneath skin • Rapid, involuntary movements in muscles of extremities or face |
| Jones Criteria | Must have two major manifestations or • One major manifestation and two minor manifestations |
| Exceptions to Jones Criteria | • Chorea may be the sole manifestation of ARF • Indolent carditis may be the sole manifestation in patient who fail to seek early medical treatment • Individuals with a history of ARF should be presumed to have recurrence manifestations. |
| Diagnostic criteria | Must have supportive evidence of antecedent group A Streptococcal pharyngitis • Positive throat culture • Positive rapid streptococcal antigen test • Elevated (especially rising) streptococcal antibody testing: |
| Minor Manifestations: | • Other arthralgias • Fever: 101 F to 104 F • Elevated acute phase reactants (ESR and CRP) • Prolonged PR Interval on ECG • Prior history of rheumatic fever |
| Major Manifestations: | Migratory Poly-arthritis Carditis Subcutaneous nodules Sydenham's chorea Erythema Marginatum |
| CXR findings: | • Cardiomegaly • Kerly B lines • Heart Failure |
| EKG | Heart block |
| Lab findings: | • + Streptococcal Antibody Titers: • ASO • AntiDNase B • ASTZ • + Streptococcal throat culture • Elevated Acute Phase Reactants (CRP and ESR) |
| Differential diagnosis (ARF has many systemic manifestations and could be confused with these due to s/s) | • Bacterial endocarditis • Viral myocarditis • Systemic Lupus • Serum Sickness • Rheumatoid arthritis • Infectious arthritis |
| Treatment goals for your pt with ARF | • Symptomatic relief of acute disease manifestations • Eradication of group A beta-hemolytic streptococcus • Prophylaxis against future infection to prevent recurrent cardiac disease |
| What therapy will slowdown the valvular portion of the disease process | There is no therapy that slows the progression of valvular damage in patients with ARF |
| Symptomatic relief: | Anti-inflammatory agents |
| Anti-inflammatory agents used for symptomatic relief of ARF | • Aspirin: 4-8 grams qd • Serum levels at 20-30mg/dl • Dramatic relief in fever and arthralgias • Continue until all symptoms are absent and ESR levels are normalized |
| Treatment of Carditis: | • Treat heart failure using conventional therapy • Treat heart block using conventional therapy • Corticosteroids: • Prednisone 2mg/kg/day • Valve repair or replacement for non- responsive heart failure |
| Antibiotics: | Antibiotic therapy with penicillin should be started and maintained for at least 10 days, regardless of the presence or absence of pharyngitis at the time of diagnosis. |
| What ABX should you use to treat a pt with ARF that also has a penicillin allergy? | • PCN allergic patients should be treated with Erythromycin |
| Children: Rx: Penicillin VK | 250mg bid-tid |
| Adults: Rx: Penicillin VK | 500mg bid-tid |
| Bicillin LA may be used IM once in lieu of | Oral penicillin |
| Children Bicillin Rx | 600,000 UNITS |
| Adults Bicillin Rx | 1.2 million UNITS |
| Antibiotic prophylaxis: | the goal of antibiotic prophylaxis against Group A Beta-Hemolytic Streptococcus is to prevent recurrence of acute rheumatic fever. |
| How long should you continue a pt on ABX prophylaxis? | Consensus seems to be that therapy should be continued at least until the patient is a young adult (18-20 years old) or five years following acute manifestation of ARF |
| According to WHO guidelines Patients with proven carditis should remain on ABX therapy until? | 5 years therapy or until age 18 |
| According to WHO guidelines Patients with mild mitral regurgitation should remain on ABX therapy until? | at least 10 years prophylaxis or until age 25 |
| According to WHO guidelines Patients with severe valve disease/replacement should remain on ABX therapy until? | Lifelong therapy |
| What is the most severe sequela of ARF | Rheumatic heart disease • Occurs 10-20 years after the original illness • Major cause of valvular heart disease worldwide • Likely to occur in at least 50% of patients with carditis on initial presentation |
| What valve is most commonly affected in rheumatic heart disease | Mitral valve (mitral stenosis) |
| Other than the mitral valve what other valve is commonly affected | The Aortic Vavlve |
| The Valve rarely affected in rheumatic heart disease | Tricuspid valve |
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