-IBIS-1.5.0-
tx
cardiovascular system
rheumatic heart disease
diagnoses
definition and etiology
definition and etiology:
An immune-mediated febrile illness following Group A streptococcal infections, characterized mainly by arthritis, chorea, or in this case, carditis appearing alone or in combination. Residual heart disease is a possible sequela. It may be accompanied by subcutaneous nodules or erythema marginatum. The valves of the heart can be permanently damaged, as well as the chordae tendinae. This can cause regurgitation, stenosis and other effects on the heart.
signs and symptoms
signs and symptoms:
pericardial rub
cardiac enlargement
congestive heart failure
fever
auscultatory findings (e.g. murmurs) and x-ray findings are subtle
lab findings: (due to complications)
elevated ESR or CRP
WBC count may reach 12,000-20,000/HPF
prolongation of the P-R interval on EKG (not always a finding)
throat cultures
elevated ASO titers
x-rays may show effusion or cardiomegaly
course and prognosis
Streptococcal infection may come and go, affecting the heart insidiously. The effects are felt years later, when the heart becomes incompetent under stress. A child may have acute abdominal pain from hepatic capsulitis or mesenteric adenitis, as the body battles the infection and lymph tissues become engorged. This can be mistaken for appendicitis. Diuretics will quickly drain the lymph tissue to help discern the diagnosis.
Joints may be severely swollen and painful during the acute disease, and for some time thereafter. It is most typically migratory and though it lasts for several weeks, does not cause permanent damage.
Chorea, though uncommon, may persist for several months.
Cardiovascular symptoms worsen with each successive episode. Prophylaxis against further strep infections is necessary.
differential diagnosis
appendicitis
juvenile RA, and other childhood arthritides like osteomyelitis and pyogenic arthritis
congenital heart disease
congestive heart failure
cardiomegaly
acute lymphocytic leukemia
acute bacterial endocarditis
innocent systolic murmurs
footnotes