ECG

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acute rheumatic fever

 delayed, nonsuppurative sequela of a

pharyngeal infection with the group A
streptococcus (GAS)
 The disease presents with various
manifestations that may include
arthritis, carditis, chorea,
subcutaneous nodules, and erythema
marginatum.

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 PATHOGENESIS
 Genetic susceptibility: the presence of
an increased percentage of D8/17+ B
cells appears to identify a population
at special risk of contracting ARF.
 Role of the streptococcus : GAS
 Importance of pharyngitis
 Molecular mimicry — As a result of
molecular mimicry, antibodies
directed against GAS antigens
crossreact with host antigens
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 CLINICAL MANIFESTATIONS
 ARF occurs most frequently in
children from 4-9 years of age
 characterized by an acute febrile
illness that may manifest itself in one
of several ways:
1. Migratory arthritis
2. Carditis and valvulitis
3. Central nervous system involvement
4. Rash
5. Some combination of the above.

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 Major manifestations:
1. Carditis
2. Polyarthritis
3. Chorea
4. Erythema marginatum S
5. ubcutaneous nodules.
Minor manifestations:
1. Fever
2. Arthralgia
3. Previous rheumatic fever or
rheumatic heart disease.
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 DIFFERENTIAL DIAGNOSIS
 There are too many diagnostic
entities to consider in the differential
diagnosis of acute rheumatic fever
1. The causes of polyarticular joint pain
in children and adults
2. unexplained fever are presented
separately

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 LATE SEQUELA OF ARF — Rheumatic
heart disease is the most severe
sequela of acute rheumatic fever.
 It usually occurs 10 to 20 years after
the original attack
 the major cause of acquired valvular
disease in the world

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Treatment of acute rheumatic fever

 Three major goals in the treatment

of acute rheumatic fever are:
1. Symptomatic relief of acute disease
manifestations
2. Eradication of the Group A beta-
hemolytic streptococcus
3. Prophylaxis against future infection
to prevent recurrent cardiac disease

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 myocarditis
 is an inflammatory disease of cardiac
muscle. It can be acute, subacute, or
chronic, and there may be either focal
or diffuse involvement of the
myocardium

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CLINICAL
FEATURES

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 Physical examination
 In addition to the signs of fluid
overload, the physical examination
often reveals direct evidence of
cardiac dysfunction in symptomatic
patients
Laboratory findings
 Routine laboratory studies of blood
and urine are typically normal or
reveal only nonspecific abnormalities.

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 Electrocardiogram
 The electrocardiogram may be normal
or abnormal in myocarditis. However,
the abnormalities are nonspecific
Chest radiograph
 The chest radiograph is also variable,
ranging from normal to cardiomegaly
with or without pulmonary vascular
congestion and edema

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 Echocardiography
 The echocardiogram has become the
most valuable means of detecting
decreased ventricular function in
suspected myocarditis, even when
subclinical
DIAGNOSIS
 When systemic manifestations of a
viral, bacterial, rickettsial, fungal or
parasitic infection are associated with
new abnormalities in cardiovascular
function

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 When acute viral infections, especially
the exanthematous diseases of
childhood due to parvovirus B19, are
accompanied by tachycardia out of
proportion to fever
 When an infectious disease presents
with evidence of pericarditis
 When a patient, particularly a young
patient, presents with clinical signs
and symptoms of an acute myocardial
infarction
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 At present, the definitive diagnosis of
myocarditis can be made only by
endomyocardial biopsy

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acute pericarditis
 the etiology is frequently presumed to be
viral or autoimmune
 most frequent cardiovascular manifestation
of AIDS
 following diagnoses were obtained: Viral
— 21 percent, Tuberculous — 4 percent,
Other bacterial — 6 percent, "Autoreactive"
(immune-mediated) — 23 percent, Uremia
— 6 percent, Neoplastic — 35 percent, 4
percent were undiagnosed and considered
idiopathic
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