Rheumatic Fever

Complications

• “If untreated, rheumatic fever can cause scarring and deformity of the cardiac structures, resulting in rheumatic heart disease”

• In the heart, inflammation damages the heart valves

• Endocardial inflammation causes swelling of the valve leaflets, and secondary erosion along the lines of leaflet contact

• Small, bead-like clumps of vegetation made up of platelets and fibrin are deposited on eroded valvular tissue and on the chordae tendineae cordis.

• Overtime, valves lose their elasticity and the leaflets adhere to each other

Prognosis

The prognosis of rheumatic fever depends on the level of heart involvement. If the heart is affected the prognosis is poor, but if the heat is less affected then the prognosis is better.

• If inflammation penetrates the myocardium, localized fibrin deposits develop and are surrounded by areas of necrosis, known as Aschoff bodies

• Cardiomegaly & Left heart failure

Complications:

•Rheumatic heart fever

• Carditis in all 3 layers of the heart affecting its ability to pump.

•Enlarged heart

•Valve damage which can cause blood to flow the wrong way.

•Left heart failure

Diagnostics

•Blood tests

• Electrocardiogram (ECG)

• Echocardiogram

Elevated measurements of WBC count, erythrocyte sedimentation rate, and C-reactive protein indicate inflammation, indicating cardiac or joint inflammation

References

Concept Map

Huether,S., McCance, K. (2017).Understanding Pathophysiology. (6th ed.). St. Louis, MO: Elsevier

Rheumatic fever. (2017, November 17). Retrieved June 29, 2018, from https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/symptoms-causes/syc-20354588

Rheumatic Fever

Risk Factors

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• Strep Throat/: pharyngeal infection: specifically from group A B-hemolytic streptococcus.

• Genetics: some people are genetically predisposed to develop rheumatic fever from group A B-hemolytic streptococcus.

• Age: More likely to occur in children from 5-15 years old.

Disease Process

Acute rheumatic fever can only develop as a sequel to pharyngeal infection by A ẞ-hemolytic streptococcus

•This happens as a result of abnormal humoral and cell-mediated immune response to group A streptococcal cell membrane antigens (M proteins)

• Immune response cross-reacts with molecularly similar self-antigens in the heart, muscle, brain, and joints, causing diffuse, proliferative, and exudative inflammatory lesions in these tissues (Huether & McCance, 2017).

•Rheumatic fever can occur after an infection of the throat with a bacterium called group A streptococcus--bacterium that give rise to strep throat and scarlet fever.

• This group of bacteria contains a protein similar to one found in specific tissues of the body, including tissues of the: heart, joints, skin and central nervous system. So immune system cells that would normally target the bacterium, may treat the body's own tissues as if they were infectious agents. This reaction results in inflammation.

Signs and Symptoms

Pathophysiology (definition)

Rheumatic fever is a systemic, inflammatory disease caused by a delayed exaggerated immune response to infection by the group A ẞ-hemolytic streptococcus in genetically predisposed individuals

Minor manifestations of acute rheumatic fever

• Fever

• Lymphadenopathy

• Arthralgia

• Nausea

• Vomiting

• Epistaxis

• Abdominal pain

• Tachycardia

Major clinical manifestations of acute rheumatic fever occur singly or in combination 1 to 5 weeks after streptococcal infection of the pharynx.

• Carditis

• Acute migratory polyarthritis

• Chorea

• Erythema marginatum

• Subcutaneous nodules

Education: