Rheumatic Fever

Rheumatic Fever

Question. Describe etiology, diagnostic criteria, complications and management of rheumatic fever.

Answer.

Etiology

1. Predisposing causes:
   Age should be 5 to 15 years.
   Sex has equal incidence
2. Genetic factors: Family incidence known.
3. Social and economic factors: Dampness, overcrowding and under nutrition increases incidence.
4. Idiosyncrasy is presumably a factor since 3% of people are involved in streptococcal epidemics develop rheumatic fever.

Major criteria Rheumatic Fever

1. Carditis: Rheumatic Fever

1. It is pancarditis involving endocardium, myocardium and pericardium.
2. It manifests as breathlessness, palpitation and chest pain.
3. Tachycardia, cardiomegaly and new or change murmurs
4. Aortic regurgitation in 50% cases.
5. Pericarditis produces frictional rub and pericardial tenderness.
6. Cardiac failure due to myocardial infarction.

2. Sydenham’s chorea: Rheumatic Fever

1. Late neurological manifestations that occurs at least three months after the episode of acute rheumatic fever when all signs disappear.
2. More common in female.
3. It is characterized by involuntary dancing movements of hands, feet or face.

3. Polyarthritis: Rheumatic Fever

1. Early feature of illness is non-specifi.
2. It is characterized by acute painful symmetric and migratory inflmmation of large joints.
3. Classical presentation is acute migratory polyarthritis.
   Pain and swelling in involved joints subside or disappear as newer joints get affcted.

4. Erythema marginatum: Rheumatic Fever

Red macules which fade in center, but remain red at the edges and occur mainly on trunk and proximal extremities on face.

5. Subcutaneous nodules: Rheumatic Fever

They are small, dense, firm, painless and are best felt over tendons and bones.

1. Nodules appear more than 3 weeks after onset ofother manifestations.

Management Acute Rheumatic Fever.

1. Treatment of acute attck: Rheumatic Fever

1. Bed rest is important to reduce joint pain and cardiac workload.
   Duration of bed rest is guided by markers of inflmmation like temperature,
   WBC count and ESR.
2. Benzathine penicillin 1.2 mu IM 4 hourly. If patient is allergic to penicillin, erythromycin 40–50 mg / kg for ten days is given.
3. Aspirin usually relieves symptom of arthritis rapidly.
   A starting dose of60 mg/kg body weight per day is given divided into 6 doses.
   The dose may be increased to 120 mg / kg body weight.
   This dose may produce severe symptoms like vomiting, tachypnea and acidosis. Aspirin is given till ESR comes to normal.
4. Corticosteroids like prednisolone produces rapid symptomatic relief than aspirin and is indicated in cases with severe arthritis or carditis.
   Prednisolone is given in doses of 1.2 mg / kg body weight till ESR comes to normal

2. Secondary prevention: Rheumatic Fever

To prevent further attck of rheumatic fever, long­term prophylaxis is needed.

1. Benzathine penicillin 1.2 mu IM is injected at the interval of 21 days.
   Further attck is unusual after the age of 21 years and treatment can be stopped.
2. To prevent chances of endocarditis prophylactic antibiotic therapy should be given.

Complications infective endocarditis

Inflmmation caused by rheumatic fever may last for a few weeks to several months. In some cases, the inflmmation may cause long­term complications.

Rheumatic heart disease is permanent damage to the heart caused by the inflmmation of rheumatic fever. Problems are most common with the valve between the two left chambers of the heart (mitral valve), but the other valves may be affcted.

The damage may result in one of the following conditions:

1. Valve stenosis: This condition is a narrowing of the valve,which results in decreased blood flw.
2. Valve regurgitation: This condition is a leak in the valve,which allows blood to flw in the wrong direction.
3. Damage to heart muscle: The inflmmation associated with rheumatic fever can weaken the heart muscle, resulting in poor pumping function.

Damage to the mitral valve, other heart valves or other heart tissues can cause problems with the heart later in life.
Resulting conditions may include:

1. Atrial firillation, an irregular and chaotic beating of the upper chambers of the heart (atria).
2. Heart failure, an inability of the heart to pump enough blood to the body.