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512649
rheumatic fever
Descripción
(Cardio) Paediatrics Mapa Mental sobre rheumatic fever, creado por v.djabatey el 29/01/2014.
Sin etiquetas
cardio
paediatrics
paediatrics
cardio
Mapa Mental por
v.djabatey
, actualizado hace más de 1 año
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Creado por
v.djabatey
hace más de 10 años
62
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Resumen del Recurso
rheumatic fever
now rare in developed world
but most important cause of heart disease in kids worldwide
incidence highest in those from socially & economically disadv areas
due to improved sanitation, use of Abx, changes in strep virulence
caused by group A beta-haem strep
in vulnerable ppl there is abnormal immune response to prior infection w/ this pathogen
mainly affects kids 5-15 years
clinical features
pharyngeal infection
fb latent interval of 2-6 weeks
then
polyarthritis
malaise
fever
Jones criteria for diag
to make diag
2 major or 1major +2 minor
+ supportive evidence of preceding group A strep
sig raised ASO titre/other strep antibodies
group A strep on throat culture
major manifestations
pancarditis (50%)
endocarditis
significant murmur
valvular dysfunc
myocarditis
may -> heart failure & death
pericarditis
pericardial friction rub
pericardial effusion
tamponade
polyarthritis (80%)
ankles, knees, wrists
exquisite tenderness, moderate redness & swelling
flitting, lasting < 1 week in a joint
but moves to other joints over 1-2 months
sydenham chorea (10%)
2-6 months after strep infection
involuntary movements & emotional lability for 3-6 months
erythema marginatum (<5%)
early manifestation
trunks & limbs
pink macular rash spreading outwards->
pink border w/ fading centre
borders can unite to give map-like outline
subcutaneous nodules
rare
painless, pea-sized, hard
on extensor surfaces
minor manifestations
fever
polyarthralgia
raised acute phase reactants
CRP
ESR
leucocytes
prolonged PR interval on ECG
chronic rheumatic heart disease
mitral stenosis
commonest form of longterm damage from scarring & fibrosis of valve
mitral valve most freq affected
sx don't develop till early adult life
but if repeated attacks of rheumatic fever w/ carditis
can occur in 20s (age)
other valves can be affected
pulmonary valve
most rarely
aortic
tricuspid
severity of valvular disease related to no of childhood episodes of rheumatic fever
Mx
acute episode
bed rest & anti-inflamm agents
if evidence of active mycarditis
echo changes
raised ESR
bed rest & limitation of exercise are essential
acute ep: aspirin
effective at suppressing inflammatory response of joints & heart
high doses needed
monitor serum levels
acute ep: symptomatic heart failure
diuretics
ACEIs
acute ep: pericardiocentesis
for sig pericardial effusions
acute ep:antistrep Abx
if any evidence of persisting infection
e.g. penicillin V for 10 days
after acute ep resolves
aim: prevent recurrence
prophylaxis
monthly benzathine penicillin injections
most effective
oral penicillin
compliance issues
if penicillin sensitive
erythromycin
length of Rx debatable
most recommend treatment to age of 18 or 21 yrs
more recently lifelong prophylaxis recommended
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