Definition of Rheumatic fever/  Environmental conditions

Rheumatic heart disease:  poverty level

 quality and availability of health care

Types of Rheumatic Fever

1. Acute rheumatic fever is a systemic
illness to a children cause by strep throat

2. Chronic Rheumatic heart Disease

(CRF) also known as rheumatic heart
disease is a chronic condition resulting
from rheumatic fever, A permanent
damaged of heart valves.

PATHOPHYSIOLOGY
Rheumatic heart disease is a complication of
rheumatic fever in which the heart valves are
damaged. Rheumatic fever is an inflammatory
disease that begins with strep throat. It can
affect connective tissue throughout the body,
especially in the heart, joints, brain and skin.

(Strep throat is a bacterial infection that

causes inflammation and pain in the throat.
This common condition is caused by group A
Streptococcus bacteria. )

( Streptococcus bacteria is a beta-hemolytic  Is an inflammatory condition which

bacterium that belongs to Lancefield serogroup responded to STREPTOCOCCALL
A, also known as the group A streptococci BACTERIA .
(GAS), causes a wide variety of diseases in
humans. )

FACTORS: (NOTE: Rheumatic fever is caused

by your body's response to a type of bacteria.
And remember the hallmarks of inflammation
which indicates the defense mechanism
towards the actual bacteria.)

1. When we get Infected by the causative

agent of Group A beta-hemolytic
streptococcus bacterium or streptococcal
pyogenes which originlly came from the
extra-cellular gram positive which can
 Rheumatic fever is common to children cause streptococcal phyngitis or strep
who are aged 5 to 15. throat. Which is why if it’s not treated it
Factors that may increase the chances of can lead to RHEUMATIC FEVER.
rheumatic fever include: 2. During the repetitive episodes of
 Having strep throat streptococcal bacterial infection and
 History of rheumatic fever recurrent acute rheumatic fever it can lead
 Untreated or under-treated strep to rheumatic heart disease.
infection How?
Additional:
3. Because, With the all layer of heart and
mitral valve can become inflamed it’ll lead
to vegetation form or abnormal growth
which can cause of valvular regurgitation
and stenosis. ( valvular regurgitation is a
kind of condition where the valve opening
does not close completely causing blood to
leak backward into the heart and stenosis
is where the valve narrows and restrict
blood flow from the heart.)
 Painless lumps (nodules) under the skin
near joints (this is a rare symptom)
 Rash that appears as pink rings with a clear
center (this is a rare symptom)
In addition, someone with rheumatic fever can
have:
 A new heart murmur
 An enlarged heart
 Fluid around the heart

(Note: The aortic valve controls blood flow (In order for us to make diagnosis we need two
from the heart to the rest of the body.) options that indicates the 2 Major criteria and
4. As a result of heart failure or RHEUMATIC 1 Major criteria + 2 minor criteria. )
HEART DISEASE.

Information regarding Group A

Streptococci and Gram- Positive
pathogen

Group A streptococci are model of extracellular

Gram positive Pathogens which can cause
Rheumatic fever/ pharyngitis.

Streptococcus pyogenes (group A
streptococcus) is an important species of gram-
positive extracellular bacterial pathogens Mnemonic: J.O.N.E.S
wherein, this disease colonize the throat or
skin. MAJOR CRITERIA:
Acute rheumatic fever and rheumatic heart J- Joint (Arthritis)
disease are the most serious autoimmune O- myOcrdium - it’s usually Carditis or
sequelae of group A streptococcal infection and Pancarditis (inflammation of the entire heart)
have afflicted children worldwide with N- Nodules/ subcutaneous nodules
disability and death. E- Erythema marginatum/ skin lesions
S- Sydenham Chorea (irregular, and aimless
Gram positive: Gram-positive cocci involuntary movements)
include Staphylococcus (catalase-positive),
which grows clusters and can cause sepsis MINOR CRITERIA:
a) Arthralgia -joint pain
Molecular mimicry is a hallmark of the b) Prolonged PR interval or first-degree
pathogenesis of rheumatic fever. atrioventricular (AV) block >200 ms
SIGN AND SYMPTOMS OF FR
Symptoms of rheumatic fever can include:
 Fever
 Painful, tender joints (arthritis), most
commonly in the knees, ankles, elbows,
and wrists
 Symptoms of congestive heart failure,
including chest pain, shortness of breath,
fast heartbeat
 Fatigue
 Jerky, uncontrollable body movements c) Fever
(called “chorea”) d) Elevated ESR/CRP
e) Val-vu-lar Dysfunction - valves 9. Echocardiography can detect the evidence
likeMitral valve and Aortic Semilunar of carditis in many patients.
Valve 10. ESR and serum CRP are sensitive and not
specific.
RHEUMATIC FEVER AN
INFLAMMATORY DISEASE THAT CAN
AFFECT THE: TREATMENT:

 Antibiotics: In order to treat the

underlying bacterial infection.
 Anti-inflammatory medications: such
as aspirin, to reduce inflammation
(swelling) or joint pain throughout the
body. This medication may also relieve
symptoms. For severe symptoms, your
provider may prescribe a stronger
medication (corticosteroids) to fight
inflammation.
TREATMENT:
 Rest: inflammation can be severe. It can
 Antibiotics: In order to treat the
cause joint soreness and stiffness. Rest
underlying bacterial infection.
may be needed for a period of time.
 Anti-inflammatory medications: such
as aspirin, to reduce inflammation
Aimed at:
(swelling) or joint pain throughout the
body. This medication may also relieve
1. Controlling inflammation
symptoms. For severe symptoms, your
provider may prescribe a stronger
2. Preventing cardiac complications
medication (corticosteroids) to fight
inflammation.
3. Preventing recurrent episodes (can't develop
 Rest: inflammation can be severe. It can
life-long immunity)
cause joint soreness and stiffness. Rest
may be needed for a period of time.
4. Bed rest until body temp normalizes without
antipyretics as for the Resting pulse rate, ECG,
DIAGNOSIS
ESR return to normal
1. Diagnosis of first episode of ARFis based
5. Salicylates (aspirin) may reduce fever and
on modified criteria of 2 major criteria or
joint pain but don't alter disease clinical course
1 major criteria and two minor criteria are
required along with evidence of preceding
6. Oral prednisone rapidly improves joint pain
evidence of GAS infection .
but doesn't prevent injury to heart
2. Sydenham's chorea alone with minor
fulfills diagnostic criteria if other causes of
7. Prevention of recurrent episodes of RF with
movement disorder is ruled out.
prophylactic antibodies
3. Testing for GAS( culture, rapid strep test,or
antistreptolysin O and anti-DNase B titers
KEY POINTS
4. Joints aspiration
5. May be needed to exclude other causes of
 Rheumatic heart disease is a condition in
arthritis (eg infections ) .The joints fluid is
which the heart valves have been
usually cloudy and yellow, with an elevated
permanently damaged by rheumatic fever.
WBC count composed primarily of
neutrophils ;the culture is negative.
 Rheumatic fever is an inflammatory
6. ECG is done on the intial evaluation.
disease that can affect many connective
7. Serum cardiac marker
tissues, especially in the heart.
8. Levels are obtained .normal cardiac
troponin 1 levels excludes prominent
 Untreated or under-treated strep infections
myocardial damage .
put a person at increased risk. Children
 who get repeated strep throat infections
are at the most risk for rheumatic fever and
rheumatic heart disease.

Types of rheumatic heart disease

Some heart problems linked to rheumatic fever

are:
 valvular heart disease
 pericarditis
 endocarditis
 heart block

Although rheumatic fever can affect any heart

valve, it most commonly affects the mitral
valve which lies between the two chambers of
the left side of the heart. The damage can cause
valve stenosis, valve regurgitation and/or
damage to the heart muscle.

Valve stenosis occurs when there is narrowing

of a valve, which restricts blood flow.
Valve regurgitation is when blood leaks
backward through a valve, instead of following
its usual direction.

The inflammation of rheumatic fever can

damage the heart muscle itself. The damage
can affect the heart’s ability to pump blood
effectively.