Tuesday, 16 November 2010

MRCP revision battle 51.1: Rheumatic fever

Today includes a triple helping of cardiology with some random topics mixed in...

MRCP revision battle 51.1: Rheumatic fever
MRCP revision battle 51.2: Hypothermia
MRCP revision battle 51.3: Dilated cardiomyopathy
MRCP revision battle 51.4: Coeliac's Disease
MRCP revision battle 51.5: Botulism
MRCP revision battle 51.6: Hypertrophic cardiomyopathy
MRCP revision battle 51.7: Bacterial vaginosis

MRCP revision battle 51.1: Rheumatic fever

Rheumatic fever is a systemic infection caused by group A beta haemolytic strep.

Diagnosis is by the revised Jones criteria which stipulates:
  • evidence of preceeding streptococcl infection AND
  • 2 major criteria OR 1 major and 2 minor criteria

Major criteria are:
  • carditis
  • polyarthritis
  • chorea
  • erythema marginatum
  • subcutaneous nodules

Minor criteria are:
  • fever
  • arthralgia
  • raised ESR/CRP
  • long PR
  • previous rheumatic fever

The cardiac histological marker is the aschoff nodule

Treatment is:
  • bed rest until CRP normal for 2 weeks
  • aspirin
  • penicillin

60% of patients with carditis develop chronic rheumatic heart disease, with the mitral valve most commonly affected.

Rheumatic fever may recur so prophylaxic penicillin should be given until the age of 30 and when dental procedures are being carried out after that.

Now for a cold topic...