Submitted by

MahNoor
Submitted to
Maj. Sana
Assignment
Mid Term
Subject
Paediatric Cardiology
Q#1
Give a comprehensive review of epidemiology ,
clinical features, criteria and management of
Rheumatic Fever?
Ans:
Rheumatic fever is a systemic illness that may occur
following Group A beta hemolytic Streptococcal ( GABHS)
pharyngitis in children.
Epidemiology:
Incidence in developed countries
~ 0.5-3/100,000
Incidence in developing countries
~ 100-200/100,000
Overall mean incidence worldwide
~5-5.0/100,000
 Rheumatic fever in 21st century appears to be largely a
disease of crowding and poverty.
 First attack between 5-15 years of age ( a childhood
disease)
 Triggered by an Immune-mediated delayed response to
infection with specific strains of group A streptococci.

Clinical Features:
 Fever
 Anorexia
 Lethargy
 Polyarthritis
 Carditis
 Sydenham chorea
  Subcutaneous nodules
 Erythema marginatum
Criteria
Major Criteria:
J : Joints (polyarthritis, hot/ swollen joints)
H : Heart (Carditis, valve damage)
N : Nodules ( subcutaneous, extensor surfaces)
E : Erythema marginatum ( painless rash)
S : Sydenham chorea ( flinching movement
Disorder)
Minor Criteria:
P : Previous Rheumatic Fever
E : ECG with PR elongation
A : Arthralgia
C : CRP and ESR elevated
E : Elevated temperature

Management Plan:

Management of acute attack:

 Single dose of benzyl penicillin
 Oral phenoxymethyl penicillin ~ 250 mg ( 6 hourly
for 10 days
 Penicillin allergic : Erythromycin or Cephalosporin
 Analgesia: optimally achieved with high doses of
salicylates

Bed rest and supportive therapy:

o Lessens joint pain and reduces cardiac workload.
 o Duration should be guided by symptoms along
with temperature, leukocyte count and ESR.
o Should be continued until these have settled.
o Return to normal physical activity but strenuous
exercise should be avoided in those who have
carditis.
o Oxygen
o Diuretics ( to clear fluid )
o ACE inhibitors ( to decrease Afterload of heart )
Diet :
o Advise nutritious diet without restrictions except
in patients with CHF.
o Patients with CHF should follow fluid restricted
and sodium restricted diet; Potassium
supplements may be necessary.

Pharmacological management :
Aspirin:
 It is anti-inflammatory.
 Relieve the symptoms of arthritis rapidly.
 Starting dose : 60 mg /kg /day ,
divided into 6 doses.
 It should be continued until ESR has fallen and
then gradually tailed off.
Corticosteroids:
 More symptomatic relief than aspirin.
 It is indicated in carditis or severe arthritis.
 Prednisolone: 1.0-2.0 mg /kg/day in divided doses.
 It should be continued until ESR is normal and then
tailed off.
Anticonvulsant medication:
  It is used for severe involuntary movements caused
by Sydenham chorea.
 Anticonvulsant: Valproic acid or Carbamazepine
Antibiotics:
 Penicillin or other antibiotics are prescribed to
eliminate remaining strep Bacteria.

Q#2
Management of SVT in flowchart?

Management of SVT

Non Pharmacological
Pharmacological

If child is
thermodynamically stable
Placing an ice bag over the
face
Valsalva maneuver
Straining rapid IV push of
adenosine
In older child calcium
channel blocker like
verapamil can b given
If child is
thermodynamically
unstable
Synchronized DC
Cadioversion
If tachycardia is resistant
IV ( procainamide , sotatol
) can be tried
If SVT is still present
Catheter ablation with
success rate of 80-90%