Rheumatic heart disease: Difference between revisions

Latest revision as of 21:19, 21 December 2021

Background

Delayed autoimmune reaction to group A streptococcal pharyngitis

Pathophysiology

Cross-reactivity of anti-streptococcal antibodies with interstitial cardiac valvular cells

Epidemiology

Occurs in about 3% of cases of untreated streptococcal pharyngitis

Clinical Manifestations

Almost always affects the mitral valve with isolate mitral stenosis being the most common
Mitral regurgitation, aortic stenosis, and aortic regurgitation also possible
Acute rheumatic fever can cause inflammation of essentially any part of the heart

Investigations

Anti-streptolysin-O titre (ASOT)
- >116 is suggestive of recent group A streptococcal infection

Complications

Carditis leading to rheumatic heart disease in 30-45% of cases

Management

Acute
- Antibiotics
  - First-line: penicillin V for 10 days
  - Alternative: amoxicillin for 10 days
- If carditis, add antiinflammatory
  - First-line: high-dose ASA 20mg/kg?? (~1.3g) po qid
  - Alternative: prednisone 1g/kg po daily with a 9-week taper
Prophylaxis, including patients with mild latent disease on echo
- Benzathine penicillin G 1.2mU IM q3-4week

@@ Line 1: / Line 1: @@
-== Definition ==
+==Background==
-* Delayed autoimmune reaction to group A streptococcal pharyngitis
+*Delayed autoimmune reaction to group A [[streptococcal pharyngitis]]
+===Pathophysiology===
-== Epidemiology ==
+*Cross-reactivity of anti-streptococcal antibodies with interstitial cardiac valvular cells
-* Occurs in about 3% of cases of untreated streptococcal pharyngitis
-== Etiology ==
+=== Epidemiology ===
+*Occurs in about 3% of cases of untreated [[streptococcal pharyngitis]]
-* Cross-reactivity of anti-streptococcal antibodies with interstitial cardiac valvular cells
-== Investigations ==
+== Clinical Manifestations ==
+* Almost always affects the mitral valve with isolate mitral stenosis being the most common
-* Anti-streptolysin-O titre (ASOT)
+* Mitral regurgitation, aortic stenosis, and aortic regurgitation also possible
-** &gt;116 is suggestive of recent group A streptococcal infection
+* Acute rheumatic fever can cause inflammation of essentially any part of the heart
-== Complications ==
+==Investigations==
+*Anti-streptolysin-O titre (ASOT)
-* Carditis leading to rheumatic heart disease in 30-45% of cases
+**&gt;116 is suggestive of recent group A streptococcal infection
-== Management ==
+==Complications==
+*Carditis leading to rheumatic heart disease in 30-45% of cases
-* Acute
-** Antibiotics
+==Management==
-*** First-line: penicillin V for 10 days
-*** Alternative: amoxicillin for 10 days
+*Acute
-** If carditis, add antiinflammatory
+**Antibiotics
-*** First-line: high-dose ASA 20mg/kg?? (~1.3g) po qid
+***First-line: [[penicillin V]] for 10 days
-*** Alternative: prednisone 1g/kg po daily with a 9-week taper
+***Alternative: [[amoxicillin]] for 10 days
-* Prophylaxis
+**If carditis, add antiinflammatory
-** Penicillin 1.2mU IM q3-4week
+***First-line: high-dose [[ASA]] 20mg/kg?? (~1.3g) po qid
+***Alternative: [[prednisone]] 1g/kg po daily with a 9-week taper
+*Prophylaxis, including patients with mild latent disease on echo
+**[[Benzathine penicillin G]] 1.2mU IM q3-4week
 [[Category:Cardiology]]