Rheumatic fever is an inflammatory disease that can occur weeks after a streptococcal throat infection. It primarily involves the heart, joints, brain, skin, and tissues under the skin. The main symptoms include inflammation of the heart (carditis), joint pain and swelling (arthritis), involuntary movements (chorea), and red rashes on the skin (erythema marginatum). Long term, repeated bouts of rheumatic fever can lead to permanent heart valve damage known as rheumatic heart disease. Treatment focuses on antibiotics to treat strep infections, pain medications, corticosteroids, and supportive care for any heart, brain or joint complications.

1. Rheumatic heart disease
&
Rheumatic fever
By- kajal sansoya

2. Introduction
• Rheumatic fever is an inflammatory disease
occurring as a delayed sequel to pharyngeal
infection with group A streptococci.
• It primarily involves heart, joints, CNS, skin &
subcutaneous tissues.

3. Etiology
• RF follow pharyngeal infection with group A
beta hemolytic streptococcus.
• Latent period between pharyngeal infection
and onset of rheumatic fever is 1-5weeks,
average duration is 19 days.

4. Epidermiology
• 2-3% people develops RF follows group A ,
beta hemolytic streptococcal pharyngitis .
• RF is world wide disease in children and
adolescents.
• It is most prevalent in areas of poor economic
conditions, overcrowding.
• Siblings are also affected.
• Peal incidence between 5-15 years.

5. Pathogenesis
• Molecular mimicry ( cross activity )
• T-cells and cytokines become activated and
causes auto reactivity of immune activity
against own body tissues.

6. Group A beta
hemolytic
streptococcus
pharyngitis
Immune
response (
cross activity)
Multi-systemic
inflammation
Fever occur &
rheumatic
fever

7. Pathology
• Acute inflammation occur due to fever.
• Acute RF is characterized by exduate and
proliferative inflammatory lesions of
connective tissues.
• Mainly involves heart, skin ,CNS , subcutaeous
tissues.

8. Effect on heart
• Rheumatic fever involves all three layer of
heart.
• RF of pericardium- rheumatic pericarditis
• RF of myocardium- rheumatic myocarditis
• RF of endocardium- rheumatic endocarditis
• Rheumatic fever of all three layer of heart
collectively called pancarditis.

9. Pericardium
• Pericarditis produces pericardial effusion and
thick serous exduate that gives the ‘bread and
butter’ appearance.
• There is fibrous accumulation in pericardium
and pericardium is then called fibrinous
pericarditis.
• When we open the pericarditis ,the layer of
pericardium gives bread and butter
appearance because of fibrinous strain inside.

10. Pericardium is most common involved.
This produces chest pain which is sharp, localized and relived by lean forward.
Because layers are rubbing in this there is pericardium rubbing sounds.

11. Myocardium
• Myocardium is contraction muscle of heart.
• RF of myocardium there is presence of
ASCHOF BODIES.
• Aschof bodies are very small inflammatory
lesions which are immune mediated
granulomas.
• This is most serious infection among all three
layers of heart.

13. • Myocardium shows the aschof bodies.
• Aschof bodies may persist for many years in
chronic rheumatic inflammation-especially in
mitral stenosis.
• Eventually, these bodies covered into spindle-
shaped or triangular scar.

14. why so serious ?
• Causes- right ventricular failure, left
ventricular failure, chronic heart failure.
• Myocarditis can produce long term
complications in acute phase because
myocardium become so loose & floppy and
can do contract well but cannot produce
enough CO. So, sometimes children’s may die
with acute rheumatic myocarditis.

15. Endocardium
• Endocaridtis produces valvulitis .
• It may later healing with fibrous thickening
and adhesions of valve commissures, leaflets
and chordae tendinease.
• End result of this is stenosis & regurgitation.
• Mitral valve is commonly involve than aortic
valve, tricuspid is rarely & pulmonary is never
involved.

16. CNS
• Effect of rheumatic fever on CNS causes
chorea.
• Chorea is involuntary rapid, aimless, irregular
movement associated with muscle weakness,
emotional instability, obsessions and
compulsions and psychotic features.
• Also called Saint vitus dance, sydenham’s
chorea.

18. Joints
• Rheumatic fever in joints causes rheumatic
arthritis.
• When multiple joints are affected at different
time it is called polyarthritis.
• Mostly affected larger joints.
• This also causes pain in joints known as
arthralgia.

19. Subcutaneous tissue
• Subcutanous nodules are similar to aschof
bodies
• They are small pea-sized, painless nodule,
over bony prominences.
• Common sites are extensor tendons of hands
and feet, scalp, occiput, spinous process.

20. Deformities due to rheumatic arthritis.

21. Skin
• Erythema marginatum is redness of skin or
mucus membrane.
• It occur in 10% cases.
• They are pink rashes with clear center and
round margins.

22. Clinical features
• Carditis
• Polyarthritis
• Arthralgia
• Subcutaneous nodules
• Erythema marginatum
• Chorea

23. Reverse John’s criteria
Major manifestations Minor manifestations
carditis fever
Polyarthritis arthragia
chorea Increase ESR, CRP
Erhthema marginatum Prolonged PR interval
Subcutaneous nodules Previous history of RF, RHD

24. Lab findings
• Isolation of group A streptococci
• Streptococci antibody test
• Blood test
• ECG- shows prolonged PR interval
• X-rays- shows cardiomegly, pulmonary
congestion
• ECHO- shows myocardial dysfunction, valvular
dysfunction, pericardial effusion.

25. Management
• Bed rest
• Anti-streptococcal therapy- penicillin
• Salicylates- aspirin
• Corticosteroids
• Supportive therapy- treatment of CHF, valvular
lesions, heart block, chorea.

26. Quiz time
1. Aschof bodies seen in
o Myocarditis
o Endocaditis
o Pericarditis
2. ECG findings for RHD shows
o Pericardical effusion
o Prolong PR interval
o Cardiomegaly

27. Thank you
Happy reading