RHEUMATIC FEVER PPT .pdf

rheumatic fever, cause and risk factors explained., pathogenesis of the acute RF, clinical manifestations mentioned properly by pictures, medical management ACC to modern science.

1. Dr.K. Malathi
MD Scholar
Dept. of. Kaya Chikitsa
DR. N.R.S. Govt Ayurvedic College
Vijayawada

2. Contents:
Definition
Incidence
Causes
Pathogenesis
Signs and Symptoms
Diagnosis
Jones criteria
Management

3. Definition
Rheumatic fever is a immunologically
mediated inflammatory disorder which
is developed as a complication of
Group A streptococcal pharyngeal
infection.
Acute Rheumatic fever remains a
preventable cause of cardiac disease.

4. Incidence
Rheumatic fever is most common in 5-15
years old children though it can developed in
younger children and adults.
In India, the prevalence of rheumatic heart
disease has been reported to be in the range
of0·12–4·54 per 1000 children aged 5–15
years
Cardiac valve damage is the most significant
complication of Rheumatic fever.

5. Causes
A strong evidence of upper
respiratory tract infections like
pharyngitis/ tonsilitis with
Hansfieldgroup A Steptococcum
beta heamolyticus–GABHS,
associated with rheumatic
strains and subsequent
development of RF.

6. RiskFactors
Genes that might make them more
likely to develop RF
Environmental factors like –over
crowding, poor sanitation easily
result in rapid transmission or
multiple exposure of strep bacteria.

7. Pathogenesis
By Antigen antibody interaction
Pharyngeal infection by group A streptococcus
Body produces antibodies against streptococci
These antiboidiescross react with human tissue (molecular
mimicry)
Immunologically inflammation and damage to human tissue
Inflammation
Rheumatic fever

8. Symptoms
Begin with1–6
weeks after
streptococci’s
infection
Low grade fever
Irregular heart
rhythm

9. Cont…
5 organs
Heart
Brain
Skin
Subcutaneous tissue
Joints

10. Heart-Carditis
Carditis -Pericarditis,
myocarditis and endocarditis
–valves involvement
Swelling/dysfunctionofthe
valvesmoslymitralvalve
thickening fibrosis
less function
regurgitation blood
heart failure

11. Manifestations
Tachycardia
Muffled heart sounds
Chest pain
Changes in ECG
COPMPLICATIONS:
Valve stenosis
Valve regurgitation
Damage to the heart muscle –affecting its
ability to function

12. Brain -Chorea
Sudden abnormal , involuntary ,
jerky movements -sydenham’s
chorea
Involuntary facialgrimaces (twisted
expression)
Muscleweakness
Muscle movements are exaggerated
by anxiety, relieved at rest

13. Joints -Polyarthritis
Swolen, red, hot
painful joints
Arthralgia
Migrating joint pains
after 1 or 2 days
different joints affected

14. Skin –Erythema marginatum
Erythematous
macules with clear
center , well
demarcated margins
Non pruritic
Effects trunk and
extremities

15. Subcutaneous nodules
Non tender swellings
Mostly locatedover
boney prominances
Aschoffbodies are
nodules found in the
hearts of individuals
with rheumatic fever.

16. Major manifestations
Pnemonic: JONES
J–Polyarthritis
O –Carditis
N–Subcutaneous Nodules
E–Erythema marginatum
S–Sydenhanschorea

17. Minor manifestations
Pnemonic: CAFEPAL
C–High CRP
A–Arthralgia
F –Fever
E–High ESR
P–Prolonged PR interval
A–Anamnesis (previous existing)
suspecting Rheumatism
L–Leukocytosis

18. Diagnosis
Medical history
Physical examination
Blood cultures-ASO titer
ESR
CRP
Antibodies to streptococcal bacteria
ECG
ECHO-CARDIOGRAM
CHESTX–Ray
Throatswab
DUCKELLS JONES DIAGNOSTIC CRITERIA –2
major criteria symptoms or 1 major +2 minor
criteria symptoms

20. Medical management
Prevention of permanent cardiac
damage
Eradication of hemolytic streptococci
Relieves thesymptoms
Antibiotics:Penicillin, Erythromycin,
Procaine, phenoxy penicillin
Cardiac medications –ACE, Diuretics

21. Anti inflammatory agents –
Naproxen, Corticosteroids
Anticonvulsants –Valproic acid,
Carbamazepine
Prophylactic treatment : Benzathine
penicillin monthly IM injection
Surgery: Repair of damages valves

22. Complication inAcute Rheumatic
myocarditis –children death rate is
increased due to flabbiness/ loose
of the myocardium/ heart dailated
is the main
cause of death .

23. Dr. K. Malathi