The document discusses clinical manifestations and criteria for diagnosing rheumatic fever and infective endocarditis. It provides the 1944 and 1956 modified Jones criteria for diagnosing rheumatic fever which include major manifestations like carditis, arthralgia, and subcutaneous nodules. It also discusses clinical features and investigations used to classify the severity of ventricular septal defects. The document concludes by outlining Duke's criteria for diagnosing infective endocarditis which defines major criteria as positive blood cultures or echocardiographic evidence of endocardial involvement and lists minor criteria like predisposing factors, fever, embolic phenomena, and immunological findings.

1. CLINICAL MANIFESTATIONS
T. DUCKET JONES CRITERIA-
EVOLUTION
THE MODIFIED JONES CRITERIA-
1944

2. Major manifestations
Carditis

3. ARTHALGIA

5. Subcutaneous nodules

6. Minor manifestations
FEVER

7. PRECORDIAL PAIN

8. Rashes

9. Epistaxis

10. CLINICAL MANIFESTATIONS
T. DUCKET JONES CRITERIA-
EVOLUTION
THE MODIFIED JONES CRITERIA-
1956

11. Major manifestations
Poly arthritis

12. Erythema marginatum

17. Peripheral signs of Aortic Regurgitation
• Demusset sign
• Corrigar sign
• Traube sign
• Mullers sign
• Durozieez sign
• Quicke’s sign
• Hills sign
• Shellys sign

18. CAUSES OF CARDIOMYOPATHY
• Genetic/Familial
• Infection—coxsackie, diphtheria
• Metabolic—mucopolysaccharadosis (MPS),
glycogenfihirage (GSD) disorders
• Nutritional—beriberi, selenium deficiency
• Endocrine—hyperthyroidism
• Connective tissue diseases—systemic lupus
erythema, (SLE), rheumatic lever Drugs—
doxorubcin, Cyclophosphamide
• Coronary involvement—Kawasaki's disease

23. Age Bladder Width (cm) Bladder Length (cm)
Newborn 3 5
Infant 5 8
Child 8 13
Older child 11 17

26. • Clinical features and Investigation findings
based on Severity of VSD

27. Features Mild Moderate Severe
Symptom Asymptomatic Tachypnea, dyspnea, feeding
difficulty
Repeated to episodes of cardiac
failure and failure to thrive
Signs Harsh pansystolic murmur with
thrill
Pansystolic murmur with mid
diastolic murmur
Pansystolic murmur with loud P2
Qp-Qs <1.5 1.5-2.0 >2.0
ECG Normal LVH Biventricular hypertrophy
CXR Normal Cardiomegaly Cardiomegaly with pulmonary
edema

31. Chest X-ray

33. Surgical Treatment Fr TOF
• Blalock-Taussig shunt; from the sub-clavian artery
to the ipsilateral pulmonary artery
• Modified B-T shunt; the graft is placed between
the sub-clavian and pulmonary arteries; the
innonimate artery or descending aorta can also
be used.
• Post's shunt; from the left pulmonary artery to
the descending aorta.
• Waterson's shunt; from the right pulmonary
artery to the ascending aorta.

35. Clinical Features of Infective
Endocarditis
• Cardiac effects of infection
• Bacterium
• Fever
• Changing or new murmur
• Spleenomegaly
• Immunological phenomenon

36. Cont…
• Glomerulonephritis
• Osler, nodules; small, tender subcutaneous
nodules seen in the pulp of the dig.
• Roth, spots, oval retinal hemorrhages with
pale centres
Embolic (Vascular) Phenomenon
• Pulmonary infarct
• Cerebral infarcts

37. Duke's Criteria for Diagnosis of IE
Major criteria
• Positive blood culture
Microorganisms typically consistent with IE
from two separate blood cultures
At least two positive cultures from blood drawn
12 hours apart
Three or four culture-positive results within an
hour of drawing blood

38. • Evidence of endocardial involvement
ECHO findings suggestive of IE
New valvular regurgitation

40. Minor criteria
• Predisposing heart disease or intravenous
drug use
• Temperature >38 °C
• Vascular phenomenon
• Immunological phenomenon
• Positive blood culture that does not confirm
with the abovementioned criteria