A case of acute rheumatic carditis with heart-block

Conclusion A case of rheumatic carditis has been studied in detail. The occurrence of heart-block has been demonstrated. This was scarcely suspected in a clinical examination. A slow pulse rate in the presence of a grave general condition was all that could suggest a heart-block. Electrocardiographical examinations revealed the true nature of the case. This sign should in any case be borne in mind in cases of rheumatic infection. A close follow-up of the case in all details shows that the block may be essentially a feature of rheumatic infection. Therapeutic measures to control the block and the progress of the disease have been depicted in charts and curves. The importance and value of adjuvant treatment of the associated blood condition with liver extract preparation has been pointed out. From the Carmich?l Medical College Hospitals, Calcutta.     

Acute rheumatic fever with three major criteria: polyarthritis, carditis and chorea. A case report

An eight-year-old girl is presented with three major criteria of acute rheumatic fever: polyarthritis, carditis and chorea. The diagnosis was confirmed with a history of pharyngitis 15 days prior to admission and with the findings of positive acute phase reactants such as elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), elevated anti-streptolysin-O (ASO) titration, and clinical findings of polyarthritis, carditis and chorea. Patient responded well to salicylate and phenobarbital treatment. The rare association of these three major criteria in acute rheumatic fever is emphasized.     

Acute rheumatic fever without early carditis: an atypical clinical presentation

The original Jones criteria, first introduced in 1944, have been modified four times and updated-revised criteria were published in 1992. A variety of clinical manifestations, which may be the presenting signs and symptoms of acute rheumatic fever, are not included in the updated-revised Jones criteria. A retrospective study was conducted on all children previously diagnosed to have acute rheumatic fever between September 1998 and September 2002. Review was focused on clinical presentation; out of 60 medical records reviewed, 4 patients with unusual clinical presentation were recognised and are reported here to highlight the potential diagnostic problems of acute rheumatic fever. They presented with atypical articular involvement, silent carditis and low-grade fever in the presence some time of a positive family history for rheumatic fever. Conclusion:a high index of suspicion and an awareness of the absence of early carditis are necessary to make the diagnosis of acute rheumatic fever.Abbreviations ARF acute rheumatic fever - PSReA post-streptococcal reactive arthritis - RF rheumatic fever     

Treatment of rheumatic carditis

Rheumatic fever and rheumatic heart disease continue unabated in most of the developing nations, affecting young individuals. Focal outbreaks of smaller magnitude have also been reported since mid 1980s from industralized western nations, where this disease had almost disappeared. Introduction of penicillin in mid 1940s had markedly changed the natural history of rheumatic fever, although the incidence of rheumatic fever declined in developed nations before that, due to better living conditions. Treatment of rheumatic fever chiefly involves use of antibiotics (penicillin) to eradicater strepcocci, and antiinflammatory drugs like salicylates or corticosteriods. Patients with severe carditis, congestive heart failure and/or pericarditis are best treated with corticosteriods as these are more potent anti-inflammatroy agents than salicylates. Salicylates may be sufficient for cases with mild or no carditis. The treatmnet must be continued for 12 weeks. Several studies have shown that valvular regurgitation, and not myocarditis, is the cause of congestive heart failure in active rheumatic carditis. Therefore surgery with mitral valve replacement or repair is indicated in cases with intractable hemodynamics due to mitral regurgitation. Development of chronic valvular lesion after an episode of rheumatic fever is dependent upon presence or absence of carditis in the previous attack and compliance with secondary prophylaxis. Recurrences due to inadequate penicillin prophylaxis are responsible for hemodynamically significant chronic valvular lesions requiring surgery     

Henoch schonlein purpura with rheumatic carditis

Henoch Schonlein Purpura with acute rheumatic carditis is a rare entity and only few cases have been reported. An 8 year-old-girl presented with abdominal pain, arthralgia and rashes and was diagnosed as a case of Henoch Schonlein Purpura. She was managed conservatively and discharged. She was readmitted after 1 week with abdominal pain, fever and cough. She developed tachycardia with gallop rhythm on the third day of admission and pansystolic murmur of mitral regurgitation. Echocardiography showed features of myopericarditis, mild pericardial effusion and mitral regurgitation. She was diagnosed and managed as a case of acute rheumatic carditis     

Are all recurrences of “pure” Sydenham chorea true recurrences of acute rheumatic fever?

We are conducting prospective studies of patients in Santiago, Chile, who have had an attack of rheumatic fever and are receiving continuous secondary prophylaxis with monthly injections of benzathine penicillin G. Throat cultures are obtained just prior to injection each month, and serum antistreptococcal antibody titers (antistreptolysin O and antideoxyribonuclease B) are performed at least every 3 months. During the course of these studies we have observed 17 recurrences of "pure" chorea in 10 patients (six girls). In four recurrences the timing of serologic studies and onset of chorea appeared to exclude the occurrence of an immunologically significant group A streptococcal infection within the preceding 6 to 9 months. In one case the period of serologic follow-up was too brief to allow a definite determination. In the remaining 12 recurrences serologic evidence was suggestive or confirmatory of recent streptococcal infection; however, in several instances the titer elevations were quite modest. Our data suggest that in certain chorea-prone patients, Sydenham chorea may recur after streptococcal infections too weak and transient to be readily detectable or, alternatively, after stimuli other than streptococcal infection.     

Electrocardiographic studies in a case of heart-block in rheumatic carditis

Summary A case of heart block in rheumatic carditis has been electrocardiographically studied. Difficulties of diagnosing the condition without mechanical aid has been pointed out. The effects of atropin in removing the block has been graphically shown. An explanation has been offered for the unusual preferential behaviour of atropin in such a case in restoring normal sinus rhythm without having any effect on the rate of the heart. I beg to acknowledge my gratefulness to Rai Bahadur H. N. Ghosh M.D. and Dr. B. Shaha for their kind permission to study this case in their ward.