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Acute Rheumatic Heart Disease

Rheumatic Fever


Presentation

  • When minor manifestations alone are present, the exclusion of other more likely causes of the clinical presentation is recommended before a diagnosis of an ARF recurrence is made (Class I, Level of Evidence C).[acc.org]
  • Low-grade carditis may present too late for diagnosis of the RF.[patient.info]
  • INVESTIGATIONS • ECG: Sinus tachycardia Sinus bradycardia First-degree atrioventricular (AV) block (prolongation of the PR interval) ST segment elevation may be present and is marked most in lead II, III, aVF, and V4 -V6 28 29.[slideshare.net]
  • This report examines and presents a range of data on acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Australia.[aihw.gov.au]
  • Susan Swedo, of the NIMH, presents at University of Wisconsin School of Medicine Grand Rounds on pediatric autoimmune neuropsychiatric disorder associated with strep infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS). ...[moleculeralabs.com]
Cyanotic Congenital Heart Disease
  • Thus, the myocardium of patients who had expired from cyanotic congenital heart disease and acute rheumatic carditis is jeopardized by ischemia, with metal contents similar to the border areas in myocardial infarction.[ncbi.nlm.nih.gov]
Aspiration
  • Joint aspiration may be needed to exclude other causes of arthritis (eg, infection). The joint fluid is usually cloudy and yellow, with an elevated WBC count composed primarily of neutrophils; culture is negative.[merckmanuals.com]
Hyperpnea
  • Salicylate toxicity is the limiting factor to aspirin therapy and is manifested by tinnitus, headache, or hyperpnea; it may not appear until after 1 wk of therapy. Salicylate levels are measured only to manage toxicity.[merckmanuals.com]
Austin Flint Murmur
  • Austin Flint's murmur is from aortic regurgitation as the vibration of the anterior leaflet of the mitral valve is buffeted simultaneously by the blood jets from the left atrium and the aorta.[patient.info]
Ankle Pain
  • Common symptoms of rheumatic fever include: small, painless nodules under the skin chest pain rapid fluttering or pounding chest palpitations lethargy or fatigue nosebleeds stomach pain painful or sore joints in the wrists, elbows, knees, and ankles pain[healthline.com]
Emotional Outbursts
  • It can also be associated with muscle weakness and emotional outbursts. Because of antibiotics , rheumatic fever is now rare in developed countries.[webmd.com]
  • outbursts, such as crying or laughing for no apparent reason.[nhp.gov.in]
Inappropriate Laughter
  • laughter If your child has a fever, they might require immediate care.[healthline.com]
Neglect
  • RF/RHD is a neglected public health problem in India. If treated, 75% of people with rheumatic fever recover completely. RHD is one of the preventable chronic disorders of heart.[nhp.gov.in]
  • PloS Neglected Tropical Diseases. 2015; 9 (9):e0004033. [ PMC free article : PMC4570761 ] [ PubMed : 26371755 ] Parnaby M. G., Carapetis J. R. Rheumatic fever in indigenous Australian children.[ncbi.nlm.nih.gov]
  • Rheumatic fever: neglected again. Science. 2009;324:37. PubMed CrossRef Google Scholar 2. Remenyi B, Carapetis J, Wyber R, Taubert K, Mayosi BM.[link.springer.com]
Motor Symptoms
  • Associated motor symptoms include loss of fine motor control, and weakness and hypotonia (that can be severe enough to be mistaken for paralysis).[merckmanuals.com]

Workup

Ventricular Hypertrophy
  • . - Right Ventricular Hypertrophy : Cor pulmonale may develop as a result of a reactive pulmonary hypertension ; - Lesions of the central nervous system : Sydenham's chorea - There is disordered and involuntary movements of the trunk and extremities.[histopathology-india.net]

Treatment

  • “Our program is improving long-term compliance to treatment with the main aim of reducing cardiac morbidity rates in the Townsville HHS.”[health.qld.gov.au]
  • Treatment for rheumatic heart disease: Specific treatment for rheumatic heart disease will be determined by your child's physician based on: Your child's overall health and medical history Extent of the disease Your child's tolerance for specific medications[chw.org]
  • This can take years to show up, so you may need regular check-ups and further treatment when you're older.[nhs.uk]
  • Following an initial diagnosis of ARF, patients require long-term treatment, including long-term antibiotic treatment to avoid further infections that may damage the heart (RHD et al, 2012; AIHW, 2013b).[pmc.gov.au]
  • Anti-inflammatory treatment Anti-inflammatory treatments include pain medications that are also anti-inflammatory, such as aspirin (Bayer) or naproxen (Aleve, Naprosyn).[healthline.com]

Prognosis

  • PROGNOSIS OF RHEUMATIC FEVER • Presence or absence of permanent cardiac damage • Cardiac status at the start of treatment • Recurrence of rheumatic fever • Regression of heart disease 41 42.[slideshare.net]
  • Insights into prognosis of valvular aortic stenosis. Circulation. 1994; 89 (2):642–650. [ PubMed : 8313553 ] Paar J. A., Berrios N. M., Rose J. D., Cáceres M., Peña R., Pérez W., et al.[ncbi.nlm.nih.gov]
  • Prognosis Rheumatic heart disease occurs in 30-45% of patients with acute RF [ 20 ] . Severe chronic valvular disease is associated with severe carditis and recurrent RF [ 21 ] .[patient.info]
  • Rheumatic fever occurs in equal numbers in males and females, but the prognosis is worse for females than for males.[emedicine.medscape.com]
  • The average age among participants who died in our study was 29.4 years, confirming the aggressive nature and poor prognosis of RHD in Uganda.[bmccardiovascdisord.biomedcentral.com]

Etiology

  • This raises the possibility of an autoimmune etiology.[histopathology-india.net]
  • The pathogenesis of RHD is complex with both environmental and genetic factors contributing to its etiology.[clinicaltrials.gov]
  • New observations on the etiology of aortic valve disease: a surgical pathologic study of 236 cases from 1990. Hum Pathol . 1993 Dec. 24(12):1330-8. [Medline] . Veinot JP. Pathology of inflammatory native valvular heart disease.[emedicine.medscape.com]
  • Group A streptococcal (GAS) pharyngitis is the etiologic precursor of acute rheumatic fever, but host and environmental factors are important.[merckmanuals.com]
  • The etiology of rheumatic fever. Lancet. 1900; 156: 861-869. In article CrossRef [5] Beattie JM. A contribution to the bacteriology of rheumatic fever. J Exp Med. 1907;9: 186-206.[pubs.sciepub.com]

Epidemiology

  • Keywords: rheumatic fever, rheumatic heart disease, group A streptococcus, epidemiology This work is published and licensed by Dove Medical Press Limited.[dovepress.com]
  • Epidemiologic implications: It is reasonable to consider individuals at low risk of ARF if they come from a setting or population with known low rates of ARF and RHD (Class IIa, Level of Evidence C).[acc.org]
  • Search Strategy A literature search was performed on PubMed to identify studies that described the epidemiology of acute rheumatic fever and rheumatic heart disease.[pubs.sciepub.com]
  • OBJECTIVES  To know about the epidemiology of the disease  To understand the pathogenesis of rheumatic heart disease  To know about the clinical features: cardiac & non-cardiac manifestations  To learn about the laboratory studies of RHD  To understand[slideshare.net]
  • Viral Pharyngitis: Clinical and Epidemiologic Findings Features suggestive of GAS infection Beefy, swollen, red uvula Fever Headache History of exposure to GAS Nausea, vomiting, and abdominal pain Pain with swallowing Patient 5 to 15 years of age Presentation[aafp.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology of rheumatic heart disease Micrograph showing an Aschoff body (right of image), as seen in rheumatic heart disease.[textbookofcardiology.org]
  • Moreover, heart-M protein cross-reactive T cells have been isolated from the myocardium and the valves of RHD patients suggesting their involvement in the pathophysiology of the disease [ 7 , 8 ].[link.springer.com]
  • A comprehensive resource provided by the World Health Organization (WHO) addresses the diagnosis and treatment. [1] Pathophysiology Rheumatic fever develops in some children and adolescents following pharyngitis with group A beta-hemolytic Streptococcus[emedicine.medscape.com]

Prevention

  • […] on preventative action, diagnosis and management of acute rheumatic fever and rheumatic heart disease, and should be considered the difinitive source of information to guide all aspects of RHD management, prevention and control across Australia.[healthdirect.gov.au]
  • Different Preventions of RHD Type of Prevention Aim (What?) Modality (How?)[circ.ahajournals.org]
  • Quick reference guides cover the following topics: Primary prevention of ARF Diagnosis of ARF Management of ARF Secondary prevention of ARF Management of RHD RHD in pregnancy RHD control programs Access the guidelines and quick reference guides on the[heartfoundation.org.au]
  • Following ARF diagnosis regular secondary prevention in the form of prophylaxis with antibiotic is started to prevent recurrent ARF and heart damage.[nhp.gov.in]
  • RHD registers are a central element of secondary disease prevention programs to prevent recurrence of ARF and reduce the occurrence or severity of RHD.[pmc.gov.au]

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