Cardiology III

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• Cardiology III
• Content
• Rheumatic fever (Etiology, diagnostic
  criteria, investigations and treatment)
  Rheumatic carditis, Infective endocarditis
  prophylaxis
• Etiology
• In susceptible individuals, there is an abnormal
  immune response to a preceding infection with
  group A ß-haemolytic streptococcus. The disease
  mainly affects children aged 5-15 years.
• CLINICAL MANIFESTATIONS
• Acute rheumatic fever is diagnosed using the
  revised Jones criteria, which consist of clinical
  and laboratory findings.
• The presence of either two major criteria or one
  major and two minor criteria, along with evidence
  of an antecedent streptococcal infection, confirm
  a diagnosis of acute rheumatic fever.
• Streptococcal antibody tests, such as the
  antistreptolysin O titer, are the most reliable
  laboratory evidence of prior infection.
• Arthritisis the most common major manifestation.
• (Arthralgia cannot be used as a minor
  manifestation if arthritis is used as a major
  manifestation).
• Carditis occurs in about 50 of patients.
• Chorea (Sydenham chorea) consists of neurologic
  and psychiatric signs. It also is uncommon and
  often presents long after the infection
• Erythema marginatum, a serpiginous, nonpruritic,
  and evanescent rash, is uncommon, occurs on the
  trunk, and is brought out by warmth.
• Subcutaneous nodules are seen predominantly with
  chronic or recurrent disease. They are firm,
  painless, nonpruritic, mobile nodules found on
  the extensor surfaces of the large and small
  joints, the scalp, and the spine.

TREATMENT AND PREVENTION Benzathine penicillin
to eradicate the betahemolytic streptococcus Salic
ylates (NSAD therapy) bed rest. Additional
supportive therapy for CHF or chorea. Long-term
penicillin prophylaxis, preferably with IM
benzathine penicillin G, 1.2 million U every 28
days, is required. Prognosis of acute rheumatic
fever depends on
the degree of permanent cardiac damage. The
severity of cardiac involvement worsens with each
recurrence of rheumatic fever.
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Chronic rheumatic heart disease
Most common is mitral stenosis. Although mitral
valve is the most frequently affected, aortic,
tricuspid and, rarely, pulmonary valve disease
may occur.

Clinical signs Fever Anaemia and pallor Splinter haemorrhages in nailbed Clubbing (late) Necrotic skin lesions Changing cardiac signs Splenomegaly Neurological signs from cerebral infarction Retinal infarcts Arthritis/arthralgia Haematuria (microscopic).
Infective endocarditis It should be suspected in
any child or adult with a sustained fever,
malaise, raised ESR, unexplained anaemia or
haematuria
Diagnosis Multiple blood cultures
Echocardiography Acute-phase reactants are
raised
Prophylaxis Antibiotic prophylaxis against
bacterial endocarditis must be given to all
children with congenital heart disease (except
secundum ASD) before dental extraction or any
potentially septic operation.