Question

• Describe the pathophysiology of acute rheumatic fever, and rheumatic heart disease and discuss the pathophysiology, clinical manifestations, evaluation (include the revised Jones Criteria), and treatment of rheumatic fever.

Answer 1

Rheumatic fever and rheumatic heart disease

Rheumatic fever is a acute inflammatory disease of the heart involving all layers.

Rheumatic heart disease is chronic condition results from rheumatic fever involving scarring and deformities of heart valves.

Pathophysiology

• Rheumatic fever results of a group A streptococcal pharyngitis, symptoms begin as immune response to organisms
• Rheumatic fever contributed to rheumatic heart disease causing cardiac lesions and valve deformities.
• After affect on inner layer ( Rheumatic endocarditis) swelling and erosion of valve leaflets and fibrin deposition on the erotic area, then begin to fibrosis of papillary muscle leads to stenosis.

Clinical manifestations

Modified Jones criteria for diagnosing Rheumatic fever

1. Major criteria

• Carditis
• Monoarthritis or poly arthritis
• Sydenham's chores
• Erythema marginatum
• Subcutaneous nodules

2.Minor criteria

• Clinical findings: Fever, polyarthralgia
• lab findings: increase ESR,WBC, CRP
• ECG: Prolonged PR interval

Treatment

• Bed rest
• Antibiotics
• Non steroidal anti inflammatory drugs
• Salicylates
• Coricosteroids