How does rheumatic fever
Rheumatic Fever
A possible complication of strep throat infection or scarlet fever that can cause a wide range of secondary symptoms from joint inflammation to heart valve damage.
How does rheumatic fever affect heart?
Some complications of rheumatic heart disease include:
- Heart failure. This can occur from either a severely narrowed or leaking heart valve.
- Bacterial endocarditis. This is an infection of the inner lining of the heart, and may occur when rheumatic fever has damaged the heart valves.
- Complications of pregnancy and delivery due to heart damage. ...
- Ruptured heart valve. ...
What are the the after effects of rheumatic fever?
- Inflammation of the heart muscle (myocarditis)
- Reduced blood flow to the heart
- Sudden cardiac death
What are the symptoms of rheumatic fever?
What are the symptoms of rheumatic fever in adults?
- small, painless nodules under the skin.
- chest pain.
- rapid fluttering or pounding chest palpitations.
- lethargy or fatigue.
- nosebleeds.
- stomach pain.
- painful or sore joints in the wrists, elbows, knees, and ankles.
- pain in one joint that moves to another joint.
What is the prognosis of rheumatic heart disease?
Severe rheumatic heart disease can require heart surgery and result in death. Having a group A strep infection does not protect someone from getting infected again in the future. People can also get rheumatic fever more than once. However, there are things people can do to protect themselves and others.
How does rheumatic fever cause valve disease?
In some people, repeated strep infections cause the immune system to react against the tissues of the body including inflaming and scarring the heart valves. This is what is referred to as rheumatic fever. Rheumatic heart disease results then from the inflammation and scarring of heart valves caused by rheumatic fever.
What heart valve is most commonly affected by rheumatic heart disease?
Rheumatic heart disease most commonly affects the mitral valve (which has only two leaflets; Figure 2) or the aortic valve, but any valve can be affected, and more than one can be involved.
What happens to mitral valve in rheumatic fever?
Rheumatic fever. A complication of strep throat, rheumatic fever can damage the mitral valve. Rheumatic fever is the most common cause of mitral valve stenosis. It can damage the mitral valve by causing the flaps to thicken or fuse. Signs and symptoms of mitral valve stenosis might not show up for years.
Why mitral valve is most commonly affected in rheumatic heart disease?
Mitral valve is more often involved than aortic valve because the pressures across the mitral valve in systole is much higher - LV pressures are much higher than the pressure in LA in systole. The warty non infective vegetations form on the atrial side of the mitral valve along the line of closure of the leaflets.
What is the most common complication of rheumatic fever?
Rheumatic fever can cause long-term complications in certain situations. One of the most prevalent complications is rheumatic heart disease....If left untreated, rheumatic fever can lead to:stroke.permanent damage to your heart.death.
Does rheumatic fever affect aortic valve?
Topic Overview. Rheumatic fever is a bacterial infection that can cause problems with the heart's aortic and mitral valves.
What valves are affected in rheumatic heart disease?
Although rheumatic fever can affect any heart valve, it most commonly affects the mitral valve which lies between the two chambers of the left side of the heart. The damage can cause valve stenosis, valve regurgitation and/or damage to the heart muscle.
Why does rheumatic fever cause mitral stenosis?
When your mitral valve isn't functioning correctly, blood and pressure build up, the left atrium enlarges, and fluid enters the lungs. The most common cause of mitral stenosis is rheumatic fever — a complication of strep throat. This infection can scar the mitral valve, causing it to narrow.
What murmur is heard with rheumatic fever?
The Carey Coombs Murmur occurs during acute rheumatic fever. Mitral valvulitis can occur causing thickening of the leaflets. A murmur is created by increased blood flow across the thickened mitral valve.
Can rheumatic fever cause heart problems later in life?
For some people, the inflammation causes long-term complications. One complication of rheumatic fever is permanent damage to the heart (rheumatic heart disease). Rheumatic heart disease usually occurs years to decades after the original illness.
What is rheumatic valvular disease?
Key points. Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. Rheumatic fever is an inflammatory disease that can affect many connective tissues, especially in the heart. Untreated or under-treated strep infections put a person at increased risk.
How does rheumatic heart disease cause mitral stenosis?
When your mitral valve isn't functioning correctly, blood and pressure build up, the left atrium enlarges, and fluid enters the lungs. The most common cause of mitral stenosis is rheumatic fever — a complication of strep throat. This infection can scar the mitral valve, causing it to narrow.
How does rheumatic fever cause mitral regurgitation?
This common heart problem can prevent the mitral valve from closing tightly and cause blood to flow backward. Rheumatic fever. Rheumatic fever is a complication of untreated strep throat. Rheumatic fever can damage the mitral valve, leading to mitral valve regurgitation early or later in life.
What are the symptoms of rheumatic fever?
These are the most common symptoms of rheumatic fever: Swollen, tender, red and extremely painful joints — particularly the knees and ankles. Red, raised, lattice-like rash, usually on the chest, back, and abdomen. Symptoms of rheumatic heart disease depend on the degree of valve damage and may include:
What is rheumatic heart disease?
Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever. An immune response causes an inflammatory condition in the body which can result in on-going valve damage.
How is rheumatic heart disease diagnosed?
People with rheumatic heart disease will have or recently had a strep infection. A throat culture or blood test may be used to check for strep.
How to treat a heart valve?
Treatment depends in large part on how much damage has been done to the heart valves. In severe cases, treatment may include surgery to replace or repair a badly damaged valve. The best treatment is to prevent rheumatic fever. Antibiotics can usually treat strep infections and keep rheumatic fever from developing.
Why does my heart murmur?
The murmur is caused by the blood leaking around the damages valve. The rub is caused when the inflamed heart tissues move or rub against each other. Along with a complete medical history and physical exam, tests used to diagnose rheumatic heart disease may include: Echocardiogram (echo).
How old do you have to be to get rheumatic fever?
This may take years to develop and can result in heart failure. Rheumatic fever can occur at any age, but usually occurs in children ages 5 to 15 years old. It’s rare in developed countries like the United States.
Can strep throat cause rheumatic heart disease?
Untreated or under-treated strep infections can increase the risk for rheumatic heart disease. Children who get repeated strep throat infections are at the most risk for rheumatic fever and rheumatic heart disease.
What is rheumatic fever?
Related Pages. Rheumatic fever (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin. Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly. Early diagnosis of these infections and treatment with antibiotics are key to preventing rheumatic fever.
What happens if rheumatic fever is not treated?
If rheumatic fever is not treated promptly, long-term heart damage (called rheumatic heart disease) may occur. Rheumatic heart disease weakens the valves between the chambers of the heart. Severe rheumatic heart disease can require heart surgery and result in death.
What is the best treatment for rheumatic fever?
Doctors treat symptoms of rheumatic fever with medicines like aspirin to reduce fever, pain, and general inflammation. In addition, all patients with rheumatic fever should get antibiotics that treat group A strep infections. People who develop rheumatic heart disease with symptoms of heart failure may require medicines to help manage this as well.
What is the purpose of antibiotics for rheumatic fever?
Preventive antibiotics help protect people who had rheumatic fever from getting it again. Doctors also call this prophylaxis (pro-fuh-LAK-sis) or “secondary prevention.” People may need antibiotic prophylaxis over a period of many years (often until 21 years old). Prophylaxis can include daily antibiotics by mouth or a shot into the muscle every few weeks.
How old is too old to get rheumatic fever?
Rheumatic fever is very rare in children younger than three years old and adults.
What are the symptoms of congestive heart failure?
Symptoms of congestive heart failure, including chest pain, shortness of breath, fast heartbeat. Painless lumps (nodules) under the skin near joints (this is a rare symptom) Rash that appears as pink rings with a clear center (this is a rare symptom) In addition, someone with rheumatic fever can have:
Is rheumatic fever contagious?
Rheumatic Fever Is Not Contagious. People cannot catch rheumatic fever from someone else because it is an immune response and not an infection . However, people with strep throat or scarlet fever can spread group A strep to others, primarily through respiratory droplets.
What does BCR stand for in rheumatic fever?
Overview of the pathogenesis of acute rheumatic fever (GAS: group A Streptococcus; BCR: B cell receptor; TCR: T cell receptor) Figure reproduced with permission from (Carapetis, et al., 2016).
How does environmental factors affect ARF?
Environmental factors affect the prevalence of ARF by increasing exposure to S. pyogenesinfections. A major environmental factor that increases the likelihood of ARF is household crowding, which facilitates the spread of S. pyogenesinfections (Quinn, 1982). In addition, it has been shown that ARF and RHD are more prevalent in rural and remote areas as well as in urban slums, but this likely reflects other risk factors, such as greater household crowding due to low socioeconomic status or limited access to medical resources (Carapetis, et al., 2016). There is also a potential link between insufficient nutrition in childhood and susceptibility to ARF, but it is unclear whether this occurs because insufficient nutrition can increase susceptibility to developing aggressive autoimmune responses to S. pyogenesinfection, or whether poor nutrition is connected to household overcrowding and other factors associated with poverty that increase susceptibility to S. pyogenesinfection (Steer, Carapetis, Nolan, & Shann, 2002).
What is the global burden of ARF?
The global burden of ARF and RHD is significant, and is predominantly found in populations living in low-resource settings (Carapetis, Steer, Mulholland, & Weber, 2005). Incidence rates of ARF are poorly documented in most low- and middle-income countries, including in populations with a high prevalence of RHD, where it is presumed that a high incidence of ARF also occurs. This relates both to the lack of infrastructure for disease surveillance in those settings, but also to a paucity of ARF cases that are presented for clinical care. It is not known if the latter issue is a result of health-seeking behavior (people with ARF who choose not to seek health care), or due to inadequate diagnosis of ARF by health staff. The latter may in turn be due to true misdiagnosis as a result of problems with training, a lack of access to diagnostic facilities (such as electrocardiography, streptococcal serology, acute phase reactant testing, and echocardiography); or possibly because many cases of ARF may be milder, or even sub-clinical, in highly endemic settings (Bishop, Currie, Carapetis, & Kilburn, 1996).
What is ARF in medical terms?
Acute rheumatic fever (ARF) results from the body’s autoimmune response to a throat infection caused by Streptococcus pyogenes, also known as the group A Streptococcus bacteria. Rheumatic heart disease (RHD) refers to the long-term cardiac damage caused by either a single severe episode or multiple recurrent episodes of ARF. It is RHD that remains a significant worldwide cause of morbidity and mortality, particularly in resource-poor settings. While ARF and RHD were once common across all populations, improved living conditions and widespread treatment of superficial S. pyogenes infections have caused these diseases to become comparatively rare in wealthy areas (Carapetis, 2007). Currently, these diseases mainly affect those in low- and middle-income nations, as well as in indigenous populations in wealthy nations where initial S. pyogenes infections may not be treated, which allows for the development of harmful post-infectious sequelae (Carapetis, 2007).
What is the most common presenting feature of ARF?
The most common presenting features of ARF are fever (>90% of patients) and arthritis (75% of patients). The most serious manifestation is carditis (>50% of patients) because it can lead to chronic rheumatic heart disease—while all other clinical features fully resolve, often within weeks.
What are the risk factors for ARF?
Risk factors for ARF and RHD include age, gender, and various environmental factors (Carapetis, et al., 2016). In terms of age, ARF largely affects children between the ages of 5 and 14 years, and initial cases of ARF can affect children even younger than this (Lawrence, Carapetis, Griffiths, Edwards, & Condon, 2013; Parnaby & Carapetis, 2010).. Recurrent episodes generally affect older children and can occur into young adulthood. Because RHD often results from cumulative damage, the peak prevalence of RHD occurs in an individual’s twenties and thirties, though the burden of RHD in children and adolescents remains substantial (Lawrence, Carapetis, Griffiths, Edwards, & Condon, 2013).
How long does it take for ARF to develop?
The development of ARF occurs approximately two weeks after S. pyogenes infection (Gewitz, et al., 2015). The clinical manifestations and symptoms of ARF can be severe and are described in the Revised Jones Criteria (Gewitz, et al., 2015). Symptoms of ARF can include polyarthritis, carditis, chorea, the appearance of subcutaneous nodules, and erythema marginatum or a rash associated with ARF (Gewitz, et al., 2015; Martin, et al., 2015). These symptoms usually require patients to be hospitalized for two to three weeks, during which time the outward symptoms resolve, but the resultant cardiac damage may persist. With repeated S. pyogenes pharyngitis infections, ARF can recur and cause cumulative damage to the heart valves (Martin, et al., 2015).
What are the symptoms of rheumatic fever?
Common rheumatic fever symptoms include: Swollen, tender and red joints, especially the large joints such as the knees, ankles and elbows. Chest pain or abnormal heartbeat.
How long does it take for a rheumatic fever to develop?
But it mostly affects young children and teenagers (ages 5 to 15). When people get rheumatic fever, it usually develops two to three weeks after an untreated strep throat or scarlet fever.
How long does a sore throat last?
because providers effectively treat bacterial infections with antibiotics. Call your provider if your child has a sore throat for more than three days. Without treatment, rheumatic fever can cause serious health problems. Appointments 800.659.7822.
What is it called when your body overreacts to a strep throat?
Healthcare providers may also call it acute rheumatic fever. It happens when the body’s immune system overreacts to a strep throat or scarlet fever infection that hasn’t been fully treated. Rheumatic fever causes your body’s immune system to attack its own tissues, causing inflammation (swelling).
Where do people with rheumatic fever live?
Where you live: Most people with rheumatic fever live in places that have limited medical resources, such as resource-poor countries. Living in an area where it’s difficult to get medication or medical care may also put you at risk. Age: Rheumatic fever mostly affects children or teenagers between 5 and 15.
Can rheumatic fever be cured?
Rheumatic fever doesn’t have a cure, but treatments can manage the condition. Getting a precise diagnosis soon after symptoms show up can prevent the disease from causing permanent damage. Severe complications are rare. When they occur, they may affect the heart, joints, nervous system or skin.
Can a weakened immune system cause rheumatic fever?
Overall health: Having a weakened immune system can increase your risk. Children who frequently get strep infections may be more likely to get rheumatic fever. Family history: If someone in your family has had rheumatic fever, other family members may be more likely to get it.
What is rheumatic fever?
Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever isn't properly treated. Strep throat and scarlet fever are caused by an infection with streptococcus (strep-toe-KOK-us) bacteria. Rheumatic fever most often affects children who are between 5 and 15 years old, though it can develop in younger children ...
How to prevent rheumatic fever?
The only way to prevent rheumatic fever is to treat strep throat infections or scarlet fever promptly with a full course of appropriate antibiotics. By Mayo Clinic Staff. Rheumatic fever care at Mayo Clinic.
What happens if a child has strep throat?
If your child has one or more episodes of strep throat or scarlet fever that aren't treated or aren't treated completely, he or she might develop rheumatic fever.
How long does it take for rheumatic fever to appear?
The onset of rheumatic fever usually occurs about two to four weeks after a strep throat infection. Rheumatic fever signs and symptoms — which result from inflammation in the heart, joints, skin or central nervous system — can include: Painful and tender joints — most often in the knees, ankles, elbows and wrists.
What causes blood to flow in the wrong direction?
A leaky valve causes blood to flow in the wrong direction. Damage to heart muscle. The inflammation associated with rheumatic fever can weaken the heart muscle, affecting its ability to pump. Damage to the mitral valve, other heart valves or other heart tissues can cause problems with the heart later in life.
Which bacteria are more likely to cause rheumatic fever?
Type of strep bacteria. Certain strains of strep bacteria are more likely to contribute to rheumatic fever than are other strains.
Which group of streptococcus infections rarely trigger rheumatic fever?
Group A streptococcus infections of the skin or other parts of the body rarely trigger rheumatic fever.
What causes rheumatic heart disease?
Rheumatic heart disease is the result of valvular damage caused by an abnormal immune response to Streptococcus pyogenesinfection, which is classified as a group A streptococcus that causes acute rheumatic fever.[6]. Acute rheumatic fever occurs around three weeks after group A streptococcal pharyngitis and can affect joints, skin, brain, and heart.[7] After multiple episodes of rheumatic fever, progressive fibrosis of heart valves can occur, which can lead to rheumatic valvular heart disease. If valvular heart disease remains untreated, then heart failure or death may occur. The precise pathophysiology is not well known.[6] Rheumatic carditis is characterized by Aschoff nodules and MacCallum plaques. Aschoff bodies are seen in nodules in the hearts affected with rheumatic fever. They result from inflammation in the heart muscle. MacCallum plaques are seen on the valves and the subendocardium in the left atrium.
What is the most common presentation of rheumatic heart disease in young people?
Mitral regurgitation is the most common presentation of rheumatic heart disease in young people. However, rheumatic heart disease is the most common cause of mitral stenosis worldwide.[9] Common descriptions of the mitral valve on echocardiography are ‘dog-leg’ ‘elbow’ or ‘hockey-stick’ deformities, which all help describe the thickening and restricted motion of the anterior mitral valve leaflet. [8]
What is the primary cause of heart disease in children and young adults worldwide?
Rheumatic fever is the primary cause of acquired heart disease in children and young adults worldwide. Rheumatic fever occurs 2 to 3 weeks after a group A beta-hemolytic streptococcal pharyngeal infection. [8]
How many people die from rheumatic heart disease each year?
It is most common in developing countries. It is responsible for 250,000 deaths in young people worldwide each year. Over 15 million people have evidence of rheumatic heart disease. [1]
What is the most common form of heart disease in children and young adults living in developing countries?
Rheumatic heart disease (RHD) is the most critical form of acquired heart disease in children and young adults living in developing countries. RHD accounts for approximately 15 to 20 percent of all patients with heart failure in endemic countries. [2]
What is the EKG for myocarditis?
Myocarditis can result in conduction disturbances in the heart. Therefore, an electrocardiogram (EKG) is necessary. An EKG can show varying forms of heart block including first-degree, second-degree, or third-degree AV block.
Is rheumatic fever a systemic disease?
Rheumatic heart disease is a systemic immune condition that occurs as a complication of rheumatic fever. This occurs after a beta-hemolytic streptococcal infection of the throat. Rheumatic heart disease is a critical form of acquired heart disease in children and adults worldwide. This activity illustrates the evaluation and management of rheumatic heart disease and reviews the role of the interprofessional team in improving care for patients with this condition.
