RHF and RHD

• What are the 5 major manifestations of RHF?

  Carditis

  Chorea

  Erythema marginatum

  Migratory polyarthritis

  Subcutaneous nodules
• What causes RHD and RHF?

  Group A Streptococcus
• One of the major criteria, this manifest inflamed joints that are hot, red, and swollen that are commonly seen in larger joints such as knees, ankles, wrists, and elbows

  Migratory Polyarthritis
• This is considered as the most serious manifestation

  Carditis
• This includes joint pain with stiffness which can be a manifestation of ARF

  Arthralgia
• This is manifested by incoordination of body movements and latent period is longer than arthritis and carditis

  Chorea
• Erythematous, serpiginous, macular lesions with pale centers, non pruritic that are primarily on the trunk and extremities that is also accentuated by warming the skin

  Erythema Marginatum
• Firm nodules that are approximately 0.5-1cm in diameter that is found at the extensor surfaces of tendons near bony prominences

  Subcutaneous nodule
• The duration of Prophylaxis for RF without carditis

  5 years or until 21 years
• The duration of Prophylaxis for those with RF with carditis but no valvular disease

  10 years or until 21 years of age
• The duration of Prophylaxis for those with carditis and persistent valvular disease

  10 years, until 40 years, or lifelong
• Antibiotic therapy: Oral penicillin/amoxicillin duration

  10 days
• Antiinflammatory therapy: Aspirin

  50-70 mg/kg/day in 4 divided doses PO x 3-5 days then 50 mg/kg/day in 4 divided doses PO x 3 weeks and half the dose x 2-4 weeks
• What medication is given if allergic to penicillin/amoxicillin?

  Erythromycin
• Erythromycin x 10 days

  Azithromycin x 5 days or clindamycin
• What medication is given who have Migratory polyarthritis, with carditis but without cardiomegaly or CHF

  Aspirin
• What medication is given to those with carditis and more than minimal cardiomegaly/CHF, and what is the duration?

  Prednisone 2 mg/kg/day in 4 divided doses for 2-3 wks followed by half the dose for 2-3 wks then taper the dose by 5 mg/24 hr every 2-3 days
• Tests that confirm RHD & RHF

  2D echo -RHD

  ECG -RHD

  Throat swab -RHF &RHD

  ASO titer (antistreptolysin O titer) - RHF