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RHEUMATIC FEVER - Coggle Diagram
RHEUMATIC FEVER
SLO1 : Describe the aetiology & morphology of acute RF & acute rheumatic carditis
AETIOLOGY
GAS
EVIDENCE
2 MAJOR MANIFESTATION
1 MAJOR + 2 MINOR MANIFESTATION
Acute RF --> RC --> RHD
JONES CRITERIA
E
ERYTHEMA MARGINATUM
CRP ELEVATED
< 5%
HOW IT LOOKS LIKE ??
1-2 INCH
PALE CENTER W/ RED IRREGULAR MARGIN
SERPIGINOUS LOOKING LESIONS
UNIQUE // TRANSIENT
AT TRUNKS / LIMBS
NON ITCHY
If applied heat ---> WORSENS
CHRONIC CARDITIS
N
NODULES
FEVER
J
JOINTS
POLYARTHRITIS
O
CARDITIS
ARTHALGIA // PROLONGED PR INTERVAL
S
SYNDENHAM CHOREA
girls 1-15 y.o
appear after 6-12 years of RF
SYMPTOMS :-
CLUMSINESS
MOOD LABILITY
DETERORIATION OF HANDWRITING
GRIMACING OF FACE
MORPHOLOGY
ACHOFF BODY
HISTOLOGICALLY :-
MONONUCLEAR // MULTINUCLEAR
ANITSCHKOW CELLS
found in pericardium // myocardium // valves
diffuse inflammation + aschoff bodies found in any layers of heart = PANCARDITIS
DESCRIBE RF
ACUTE
INFECTED BY S.PHARYNGITIS // GAS PHARYNGITIS
RF --> RC --> RHD
affect
skin
heart
nervous system
joints
PATHOGENESIS
GAS ag cross reach w/ host proteins
S. pharyngitis ---> throat inflammation
S. pyogenes = GABH
Ab & CD4 + T cells which supposed to direct against M proteins of streptococci
BUT IT ALSO DIRECT AGAINST SELF Ag in heart
CD4 + T cells that are specific for streptococal peptides ALSO REACT W/ PROTEINS IN HEART
CYTOKINES
ACTIVATE MACROPHAGES
1 more item...
MARKERS OF RF
ANTIHYALURONIDASE
ANTI-DNASE B
ANTISTREPTOLYSIN O
SLO2 : Describe involvement of other organ in RF
SKIN
SKIN NODULES
ERYTHEMA MARGINATUM
HEART
ARTHRITIS
SELF LIMITED
NO CHRONIC DEFORMITIES
LARGE JOINTS
KIDNEY
SLO3 : Describe chronic RHD
Involve mitral valve
fibrous bridging + calcification
fish mouth // buttonhold stenoses
Tight mitral stenosis
LA dilates
Mural thrombi
EMBOLISM
CAUSE MIRAL STENOSIS
Narrowing of mitral valve
obstruct blood flow
MIRAL VALVULITIS
STENOSIS
Mural thrombi --> systemic thrombi
LUNGS = Firm & heavy
LA = dilated & hypertrophy
Right heart affected
LEAFLETS = Thick // rigid // interadherent
REGURGITATION
LV = hypertrophy & dilated
REFRACTED LEAFLETS
AORTIC VALVULITIS
STENOSIS
VALVE CUSP = Thickened // firm // interadherent
rigid triangular channel
LV = hypertrophy & dilated & failure
Scarring of valve leaflets
stiff // thickened valve
ORIFICE = Stenotic
valve orifice = fishmouth
ANATOMIC CHANGES
COMMISSURAL FUSION & SHORTENING
THICKENING & FUSION OF TENDINOUS CORDS
LEAFLET THICKENING
DIFFERENCES BETWEEN :-
RHD
SMALL / WARTY VEGETATIONS
AT LINES OF CLOSURE OF VALVE LEAFLETS
IE
AT VALVE CUSP --> EXTEND TO CHORDAE
LARGE / IRREGULAR MASS
NBTE
SMALL / BLAND VEGETATIONS
AT LINE OF CLOSURE
LSE
SMALL / MEDIUM SIZED VEGETATION
AT EITHER / BOTH VALVES LEAFLETS
SLO5 : State the diagnosis prognosis
GOOD PROGNOSIS
Older pt
No carditis during initial attack
BAD PROGNOSIS
Younger pt
Have carditis w/ valvar lesion
SLO4 : Describe its clinical feature, lab findings & diagnosis
CLINICAL FEATURES
MAJOR
MINOR
PROLONGED PR INTERVAL
FEVER
INCREASED CRP LEVEL
LEUKOCYTOSIS
ARTHALGIA