Rheumatic Fever and Atherosclerosis

Study Notes

Acute rheumatic fever (ARF) commonly affects children aged 5-15 years and is a leading cause of acquired heart disease in this age group.
ARF is triggered by an immune-mediated response to group A streptococcus infection, leading to inflammation in the heart, joints, and skin.
Major clinical manifestations include carditis, polyarthritis, and subcutaneous nodules; minor criteria involve fever and elevated inflammatory markers.
Aschoff nodules are pathognomonic for ARF and specifically occur in the heart.
Diagnosis follows the revised Jones criteria, requiring either two major manifestations or one major plus two minor criteria with evidence of antecedent streptococcal infection.

Typically presents 2-3 weeks post-streptococcal pharyngitis with fever, lethargy, and joint pain; arthritis affects approximately 75% of patients.
Subcutaneous nodules, painless and firm, can appear on extensor surfaces, usually more than three weeks after initial symptoms.
Erythema marginatum is a rare rash seen in under 5% of cases, characterized by red macules with clear centers.
Sydenham's chorea may occur as a late neurological manifestation, usually three months post-infection, presenting with involuntary movements.

Non-specific tests include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to assess systemic inflammation.
Specific testing involves anti-streptolysin O (ASO) titers to confirm a previous streptococcal infection.
Electrocardiography (ECG) may reveal tachycardia, while echocardiography assesses for valvular abnormalities or pericardial effusion.

Initiate treatment with benzyl penicillin or alternative antibiotics for allergic patients.
Bed rest and supportive care are critical to reduce symptoms and cardiac workload.
Aspirin is used for pain relief in arthritis, with doses adjusted based on symptoms and biomarkers.
Corticosteroids may be prescribed for severe cases of carditis or arthritis, tapering once inflammatory markers normalize.

Atherosclerosis is characterized by the thickening of arterial walls due to plaque buildup, primarily affecting larger arteries and leading to cardiovascular diseases.
Risk factors include smoking, hypertension, hypercholesterolemia, diabetes mellitus, and obesity, all promoting endothelial dysfunction and inflammation.

Smoking is the most significant modifiable risk factor, especially in individuals under 70 years.
Hypertension correlates with increased atherosclerosis risk due to elevated systolic and diastolic blood pressure.
High serum cholesterol levels are directly associated with greater risk for cardiovascular disease (CVD).
Diabetes, particularly type 2, presents a robust risk factor and is often linked to diffuse vascular disease.
Regular physical activity mitigates risk, while inactivity considerably heightens chances of coronary artery disease and stroke.
Diets lacking in fruits, vegetables, and healthy fats raise CVD risk, while Mediterranean-style diets can lessen cardiovascular events.

Personality traits and social deprivation are linked to increased CVD risk due to lifestyle factors like smoking and alcohol consumption.
Excessive alcohol intake can lead to hypertension and further cardiovascular complications.
Management of obesity is critical, as it independently contributes to atherosclerosis while being associated with other adverse risk factors.

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