Cardiac Round 4:
Acquired Heart Disease:
Rheumatic Fever
Kawasaki Disease
Infective Endocarditis

Rheumatic fever (ARF)

Follows streptococcal pharyngitis
Thought to be an auto immune response
3 organ systems affected
  • Heart
  • Central nervous system
  • Joints

Major Manifestations:
Sydenham’s Chorea
Erythema marginatum
Subcutaneous nodules

Minor Manifestations:
Elevated erythrocyte sedimentation rate (ESR)
Elevated C-reactive protein (CRP)
Prolonged PR on ECG

Supporting evidence:
Positive throat culture
Elevated streptococcal antibody titer
Possibly new systolic murmur

Antibiotics PCN
Prophylactic antibiotics later prior to invasive surgery
High dose aspirin/antacids
Outpatient/ family teaching

Example of Sydenham's Chorea

Associated with
Streptococcal infections

Rheumatic Fever

Difference between Scarlet fever and rheumatic fever since they are both caused by strep?
"Scarlet fever is a fever caused by Group A beta hemolytic Streptococcus bacteria which cause infection, particularly strep throat. This bacteria produces toxins. These toxins cause rashes in the body which are more evident under the arms and in the groin. Their face also becomes reddish while the area around the lips is pale. The treatment for scarlet fever is antibiotics such as penicillin or erythromycin. If not treated, it can cause rheumatic fever and sepsis which should be avoided.

Rheumatic fever, on the other hand, is a complication of scarlet fever particularly the strep throat. It is also caused by a Group A Strep infection. This occurs after a month of having strep throat. The signs of rheumatic fever are arthritis or painful, swollen joints and fever. The usage of antibiotics can prevent rheumatic fever from occurring after a strep infection. If the toxins from the strep throat descend into the heart, it can cause rheumatic heart disease. In the long term, it may damage the heart valves that may cause heart failure. This requires immediate surgery to the valves of the heart. So to prevent this, prevention is better than the cure.

Rheumatic fever affects young people usually from ages 5 and above up to 17 years old. Scarlet fever also affect the young people, but babies should be monitored as well if they are diagnosed with it.
Scarlet fever is diagnosed through blood tests. The results show leukocytosis, neutrophilia, high ESR, and C-Reactive protein. It also shows elevated anti-streptolysin O titer. Rheumatic fever is diagnosed through Jones Criteria made by Dr. Duckett Jones in 1944. This was then revised by the American Heart Association with the help of other groups. The Jones Criteria is made up of major and minor criteria. Rheumatic fever is confirmed with the presence of one major criterion plus two minor criteria and presence of infection, or two major criteria plus two minor criteria and presence of infection."

Read more: Difference Between Rheumatic Fever and Scarlet Fever | Difference Between | Rheumatic Fever vs Scarlet Fever

Kawasaki Disease:
Multi system vasculitis, proclivity toward coronary arteries

Conjunctival redness, photophobia
Erythematous rash
Oral changes, strawberry tongue, cracking lips, diffuse red oropharyngeal mucosa
Lymphadenopathy (unilateral cervical nodes)
Changes in the hands and feet, edematous, desquamation (peeling)

Intravenous immune globulin
Occasionally Methylprednisolone
Anticoagulation if giant aneurysms

Nursing Management:
S&S of CHF
Administration of IG ( same as blood product administration)

Supportive nursing care:
soft foods
lip balm
adequate intake output
child life
Family teaching

Infective Endocarditis:


O'Brien, P., & Baker, A. L. (2009). Chapter 25: The child with cardiovascular dysfunction. In M. J. Hockberry & D. Wilson (Eds.), Wong's essentials of pediatric nursing (8th ed., pp. 861-910). St. Louis, MO: Mosby Elsevier.

Difference Between Rheumatic Fever and Scarlet Fever | Difference Between | Rheumatic Fever vs Scarlet Fever

Rhematic fever

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