Rheumatic fever

priyasai20
Mind Map by priyasai20, updated more than 1 year ago
priyasai20
Created by priyasai20 about 6 years ago
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Mind Map on Rheumatic fever, created by priyasai20 on 12/01/2013.
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Rheumatic fever
1 Streptococcal infection of URT
1.1 M antigens react with T cell and stimulate B cell to produce auto antibodies
1.1.1 Recurrent infection of Heart muscles
1.1.1.1 Myocardium - aschoff noduels ~ fibrinoid degenration + lymphocytes & Plasma cells ;
1.1.1.1.1 Tachycardia, s3 & s4, CHF
1.1.1.2 Endocardium - valvulitis, damaged chordae tendinae, regurgitations - MaTP
1.1.1.2.1 Mid diastolic murmur (carey coombs),
1.1.1.2.2 valve thickening, scarring, calcification and stenosis
1.1.1.2.2.1 Pansystolic murmur
1.1.1.3 Pericardium - effusion; bread and butter appearance
1.1.1.3.1 pain, friction rub
1.1.2 other Manifestations
1.1.2.1 Joints
1.1.2.1.1 Large Joint inflammation
1.1.2.1.1.1 Migratory
1.1.2.2 Syndenham's Chorea
1.1.2.2.1 characteristic movements of limbs, head and tongue
1.1.2.2.1.1 Manifests late and relsoves in 6 weeks
1.1.2.3 Subcutaneous nodules
1.1.2.3.1 In severe carditis; Over bony prominences
1.1.2.3.1.1 resolves in 2 weeks
1.1.2.4 Erythema marginatum
1.1.2.4.1 Pink rashes: Clear centre and serpiginous margins
2 Investigations
2.1 Blood
2.1.1 ESR
2.1.2 CRP
2.1.3 Antistreptolysin O, Anti DNAse B
2.2 Throoat Swab Culture
2.3 Chest X-ray
2.4 ECG
3 REVISED JONES CRITERIA 2 Major/ 1 Major+2 minor / 5 minors
3.1 Major
3.1.1 Carditis
3.1.2 Polyarthirtis
3.1.2.1 Major criteria: 2 or more jts, high stretocococcal antibody titre
3.1.3 Chorea
3.1.4 Erythema marginatum
3.1.5 Subcutaneous nodules
3.2 Minor
3.2.1 Fever
3.2.2 Arthralgia
3.2.3 Prev RHD
3.2.4 CRP and ESR raised
3.2.5 ECG: Prolonged PR
4 Treatment
4.1 Bed rest
4.2 Antibiotics
4.2.1 Benzathine penicillin 1.2m units
4.2.2 Procaine penicillin 6L units
4.2.3 Sensitive cases - Erythromycin 20- 40mg/kg
4.3 Arthritis
4.3.1 Aspirin 60mg-8g
4.4 CHF
4.4.1 Prednisolone
4.5 Chorea
4.5.1 Calm environment, Valproic acid, Immunoglobulins
4.6 Prophylaxis:
4.6.1 Secondary
4.6.1.1 1.2m units Benzathine penicillin, Oral penicillin 500mg, Amoxycillin 1g/day, azithromycin 500mg/day
4.6.1.1.1 No carditis
4.6.1.1.1.1 For 5 yr or till 18yr age
4.6.1.1.2 resolved carditis
4.6.1.1.2.1 For 10yr or till 25yrs age
4.6.1.1.3 severe carditis
4.6.1.1.3.1 Life long prophylaxis; surgery
4.6.2 Primary
4.6.2.1 Benzathine penicillin, procaine penicillin, Erythromycin
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