Rheumatic fever physical examination: Difference between revisions
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*[[Tachycardia]] | *[[Tachycardia]] | ||
*[[Cardiac murmurs]] may be noted if heart valves are involved. Regurgitant murmurs are common in acute rheumatic fever, while chronic rheumatic fever is associated with murmurs of valve stenosis. [[Mitral insufficiency]] ([[holosystolic murmur]]) is the most common valvular abnormality reported in rheumatic fever and may be accompanied by [[aortic insufficiency]] ([[early diastolic murmur]])<ref name="pmid1404745">{{cite journal| author=| title=Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. | journal=JAMA | year= 1992 | volume= 268 | issue= 15 | pages= 2069-73 | pmid=1404745 | doi= | pmc= | url= }} </ref><ref name="pmid12417554">{{cite journal| author=Ferrieri P, Jones Criteria Working Group| title=Proceedings of the Jones Criteria workshop. | journal=Circulation | year= 2002 | volume= 106 | issue= 19 | pages= 2521-3 | pmid=12417554 | doi= | pmc= | url= }} </ref>. | *[[Jugular venous distension]] may be noted if the patient has [[congestive heart failure]] secondary to valvular involvement or [[myocarditis]]. | ||
*[[Precordial heave]]<ref name="pmid4233112">{{cite journal| author=Dressler W| title=Precordial heave on the right related to left-atrial enlargement. | journal=JAMA | year= 1968 | volume= 205 | issue= 9 | pages= 642-3 | pmid=4233112 | doi= | pmc= | url= }} </ref> may be noted in chronic rheumatic disease with mitral valve involvement<ref name="pmid17786377">{{cite journal| author=Dray N, Balaguru D, Pauliks LB| title=Abnormal left ventricular longitudinal wall motion in rheumatic mitral stenosis before and after balloon valvuloplasty: a strain rate imaging study. | journal=Pediatr Cardiol | year= 2008 | volume= 29 | issue= 3 | pages= 663-6 | pmid=17786377 | doi=10.1007/s00246-007-9047-5 | pmc= | url= }} </ref>. | |||
*[[Cardiac murmurs]] may be noted if heart valves are involved. Regurgitant murmurs are common in acute rheumatic fever, while chronic rheumatic fever is associated with murmurs of valve stenosis. | |||
**[[Mitral insufficiency]] ([[holosystolic murmur]]) is the most common valvular abnormality reported in rheumatic fever and may be accompanied by [[aortic insufficiency]] ([[early diastolic murmur]])<ref name="pmid1404745">{{cite journal| author=| title=Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. | journal=JAMA | year= 1992 | volume= 268 | issue= 15 | pages= 2069-73 | pmid=1404745 | doi= | pmc= | url= }} </ref><ref name="pmid12417554">{{cite journal| author=Ferrieri P, Jones Criteria Working Group| title=Proceedings of the Jones Criteria workshop. | journal=Circulation | year= 2002 | volume= 106 | issue= 19 | pages= 2521-3 | pmid=12417554 | doi= | pmc= | url= }} </ref>. | |||
**[[Aortic stenosis]] ([[systolic ejection murmur]]) or [[mitral stenosis]] ([[mid diastolic murmur]]) may be noted in chronic rheumatic fever secondary to scarring and calcification of damaged valves. | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S.
Physical Examination
General appearance
High index of suspicion is required in diagnosing rheumatic fever. Patients presents frequently with joint involvement and fatigue.
Vital signs
- Fever
- Normotension or Hypotension (if heart or pericardium is involved)
- Tachycardia
- Tachypnea (if heart valves, pericardium or myocardium are involved leading to cardiac dysfunction)
Cardiac examination
Cardiac involvement is the second most common complication of rheumatic fever.
- Tachycardia
- Jugular venous distension may be noted if the patient has congestive heart failure secondary to valvular involvement or myocarditis.
- Precordial heave[1] may be noted in chronic rheumatic disease with mitral valve involvement[2].
- Cardiac murmurs may be noted if heart valves are involved. Regurgitant murmurs are common in acute rheumatic fever, while chronic rheumatic fever is associated with murmurs of valve stenosis.
- Mitral insufficiency (holosystolic murmur) is the most common valvular abnormality reported in rheumatic fever and may be accompanied by aortic insufficiency (early diastolic murmur)[3][4].
- Aortic stenosis (systolic ejection murmur) or mitral stenosis (mid diastolic murmur) may be noted in chronic rheumatic fever secondary to scarring and calcification of damaged valves.
References
- ↑ Dressler W (1968). "Precordial heave on the right related to left-atrial enlargement". JAMA. 205 (9): 642–3. PMID 4233112.
- ↑ Dray N, Balaguru D, Pauliks LB (2008). "Abnormal left ventricular longitudinal wall motion in rheumatic mitral stenosis before and after balloon valvuloplasty: a strain rate imaging study". Pediatr Cardiol. 29 (3): 663–6. doi:10.1007/s00246-007-9047-5. PMID 17786377.
- ↑ "Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association". JAMA. 268 (15): 2069–73. 1992. PMID 1404745.
- ↑ Ferrieri P, Jones Criteria Working Group (2002). "Proceedings of the Jones Criteria workshop". Circulation. 106 (19): 2521–3. PMID 12417554.