RHEUMATIC FEVER

RHEUMATIC FEVER

Another popular topic in MRCP cardiology, common questions being asked in MRCP part 1 as well as part 2 are as follow,

a) Duckett Jones criteria to diagnose rheumatic fever,
b) Relationship between rheumatic fever and streptococcal infection,
c) Common presentations of rheumatic fever
d) Acute treatment for rheumatic fever

Why is rheumatic fever so important in MRCP? I think it is because the major cause of valvular heart diseases in developing countries is still chronic rheumatic disease.

DUCKETT JONES CRITERIA

The mnemonic to remember SPEC2 + WAFER2

Major Criteria

Subcutaneous nodule
Polyarthritis-described as migratory
Erythema marginatum
Carditis – pancarditis, usually in acute setting, no murmur can be heard, but there is possibility of mid-diastolic murmur ( Carey Coombes murmur)
Chorea- Sydenham’s chorea

Minor Criteria

White cells- raised ( leucocytosis)
Arthragia
Fever
ESR- raised or CRP
Rheumatic fever ( previous history)
PR interval prolonged

Diagnosis: Recent Streptococcal infection ( raised ASOT) + 2 majors or 1 major and 2 minors.

Streptococcal Infection and Rheumatic fever

Rheumatic fever usually occurs 3 weeks after Group A streptococcal infection.

Acute Treatment

Penicillin + aspirin ( high dose) and +/- steroid ( prednisolone)