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  • Rheumatic Fever

    Definition

    Rheumatic fever is an inflammatory condition. It involves the connective tissue in the body. The most severe complication is rheumatic heart disease. This condition may permanently damage the heart valves. Valves control the flow of blood to and from the heart.
    Diseased Heart Valve
    Diseased Aortic Valve
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    Causes

    Rheumatic fever is caused by group A Streptococcus pharyngitis, also known as strep throat. In this case, the body uses antibodies to fight the infection, but the antibodies also attack the heart.

    Risk Factors

    Factors that may increase your risk of rheumatic fever include:
    • Having strep throat
    • Prior case of rheumatic fever
    • Age: 5 to 15 years old

    Symptoms

    Symptoms usually appear 2 to 4 weeks after a strep infection. They may include:
    • Pain and swelling in large joints
    • Fever
    • Weakness
    • Muscle aches
    • Shortness of breath
    • Chest pain
    • Nausea and vomiting
    • Hacking cough
    • Circular rash
    • Lumps under the skin
    • Abnormal, sudden movements of arms and legs

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. This will include a careful exam of your heart.
    Other tests may include:
      Samples may be taken of your bodily fluids and tissues. This can be done with:
      • Blood tests
      • Throat culture
      You may need to have pictures taken of your heart. This can be done with:
    • You may need to have your heart activity measured. This can be done with an electrocardiogram.

    Treatment

    The goals of treatment are to:
    • Kill the strep bacteria
    • Treat the inflammation caused by the rheumatic fever
    • Treat any cardiac problems
    • Prevent future cases of rheumatic fever
    Treatment may include:

    Medication

    To treat the strep infection:
    • Penicillin or other antibiotics such as erythromycin and azithromycin
    • May be given by mouth or injection
    To help with joint pain and swelling:
    • Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs)—only if advised by your doctor
    • Corticosteroids may be used if NSAIDs are not effective or if there is inflammation of the heart

    Rest

    In some cases, the inflammation can be severe. You may have to rest for a period of time.

    Prevention

    It is important to treat strep throat with antibiotics right away. This will help prevent rheumatic fever. If you or your child has a sore throat and a fever that lasts more than 24 hours, contact your doctor.

    RESOURCES

    American Heart Association http://www.heart.org

    National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca

    References

    Acute rheumatic fever. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 27, 2012. Accessed February 14, 2013.

    Nausieda PA, Grossman BJ, Koller WC: Sydenham chorea: an update. Neurology . 1980;30:331-334.

    Rheumatic fever. Texas Heart Institute website. Available at: http://www.texasheartinstitute.org/HIC/Topics/cond/rheufev.cfm. Updated October 2012. Accessed February 14, 2013.

    Robertson KA, Volmink JA, Mayosi BM. Antibiotics for the primary prevention of acute rheumatic fever. BMC Cardiovasc Disorders . 2005; 5:11.

    Spagnuolo M, Pasternack B, Taranta A. Risk of rheumatic fever recurrences after streptococcal infections: prospective study of clinical and social factors. N Engl J Med . 1971;285:641-647.

    Revision Information

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