Acute Rheumatic Fever and Heart Disease Howard Sacher, D.O. Long Island Cardiology and Internal Medicine

Uncommon in the USA but overlooked Peak incidence is between ages 5-15 Diagnosis is based on the Jones Criteria and confirmation of Strep infection May involve the mitral valve most commonly, but other valves can also be affected

RF is a systemic immune process 2 nd to hemolytic strep infection S/S commence 2-3 weeks post infection But ranges from 1-5 weeks Must evaluate new immigrants for RF RF is rare before 4yoa and after 40yoa Pathopneumonic lesion: Perivascular granulomatous rxn with vasculitis MV is attacked 75-80% AoV is attacked 30%, but rarely is it the only valve affected TV and PV is attacked 5% of the time

Dx with Jones Criteria Presence of – 2 major criteria or – 1 major and 1 minor criteria

Jones Criteria Major: Carditis Erythema Marginatum with subcutaneous nodules Sydenham’s chorea Arthritis Minor: Fever Polyarthralgias Reversible Inc PR interval Inc ESR Evidence of antecedent group B hemolytic Strep infection Hx of RF

DDX of RF Rheumatoid Arthritis Osteomyelitis Endocarditis Chronic meningococemia “Surgical Abdomen SLE Lyme Disease Sickle Cell Anemia A host of other diseases

Complications CHF Arrhythmias Pericarditis with effusion Rheumatic pneumonitis

Treatment Strict bed rest until temperature returns to normal without medications and ESR is normal (<100/min in adults) Medications: Salicylates Benzathine - PCN

Prevention and Prognosis Early treatment of Strep Pharyngitis Immediate mortality is 1-2% with initial episode Persistent RF with cardiomegaly, mortality is poor – 30% Rheumatic heart disease (RHD) can ensue in Adults with a single or recurrent attacks of RF

RHD Valve cusps become rigid and deformed Fusion of commissures Shortening and fusion of Chordae Tendinae Valvular Stenosis and insufficiency ensues First clue of organic valvular disease is a murmur Most accurately Dx with echocardiography