2025 – PAGE 135 – CARDIOLOGY

RHEUMATIC FEVER & RHEUMATIC HEART DISEASE

PEARL: Know this section! cold. Rheumatic Fever (RF) is a VERY testable topic. The only way to exclude it as an answer is to know what it is… and know what it isn’t! Rheumatic fever is the most common cause of acquired heart disease worldwide.

RHEUMATIC FEVER

Rheumatic fever is caused by Group A Streptococcus (GAS, AKA Strep PYOGENES) infection.

JONES CRITERIA FOR RHEUMATIC FEVER

The three ways to diagnose Rheumatic Fever using the Jones criteria are listed below. Note that evidence of a previous Group A Strep infection is required in any case.

• Patient meets 2 of the MAJOR Jones criteria.
• Patient meets 1 major AND 2 minor criteria.
• Patient has previous history of acute rheumatic fever (ARF) or rheumatic heart disease and meets 3 minor criteria.

 PEARL: “Evidence” of a previous Group A Strep infection can be in the form of a positive throat cultures, a rapid strep test, elevated (or rising) antistreptococcal antibody titers including antistreptolysin O (ASO) or antideoxyribonuclease B (ADB). Note that the rapid test and culture may be negative in a recently resolved pharyngitis, so titers tend to correlate better with recent infection.

MAJOR JONES CRITERIA FOR ACUTE RHEUMATIC FEVER

Major Jones Criteria for acute rheumatic fever include:

• An asymmetric, migratory, polyarthritis of the large joints (ankles, knees, wrists)
• Signs of carditis: Valves, myocardium, and pericardium can be affected so look for new murmurs, CHF, cardiomegaly, and pericarditis.
• Painless, firm subcutaneous nodules (wrists, elbows, knees)
• (DOUBLE TAKE) ERYTHEMA MARGINATUM
  • Erythemamarginatum is a transient, erythematous, macular and light colored. It is described as being “SERPENTiginous” (snakelike) and the MARGINs are noted progress as the center clears. It is part of the Jones criteria for Rheumatic Fever.
  • IMAGE: www.pbrlinks.com/ERYTHEMA1
  • MNEMONIC: The E in Erythema is part of the E in jonEs, and the name MARGINatum should remind you to look for an interesting description of the rash’s MARGINs. Erythema MARGINatum.
• Sydenham’s Chorea: Movements of the face and/or extremities without purpose. Some describe it as “purposeless dancing.”