Rheumatic endocarditis

Rheumatic endocarditis is an acute inflammatory disease that occurs 2-4 weeks after streptococcal tonsillitis or pharyngitis (after infection of the pharynx or tonsils with β-hemolytic streptococcus group A, rarely group C or G). Rheumatic fever is a systemic disease in which the following can occur:


 * joints (migrating arthritis),


 * heart (pancarditis),


 * CNS (chorea minor)


 * skin (erythema marginatum, subcutaneous nodules).

Some parts of the streptococcus bacteria have antigenic potential and thus stimulate cellular and humoral immunity. Cross-reaction produces antibodies that can react with cardiomyocytes to form myocarditis, endocardial cells to form endocarditis, and more rarely on neurons to form chorea.

As far as the endocardium is concerned:


 * the mitral valve is most often affected (mitral regurgitation, mitral stenosis), l
 * Less often the aortic valve (aortic regurgitation in combination with aortic stenosis).


 * Often in rheumatic heart disease we also see AV-blockade I., II. or III. degrees.

In rheumatic fever, all three layers of the heart wall can be affected. In this case, we speak of so-called pancarditis, which is a combination of concurrent endocarditis, myocarditis and pericarditis.

The involvement of the heart in rheumatic fever is always a very serious condition, which can result in heart failure or death due to severe myocarditis or a hemodynamically severe valve defect.

Clinical symptoms
Clinical signs include


 * fever,


 * fatigue,


 * palpitations


 * shortness of breath, or other signs of cardiac insufficiency.

Diagnosis
Diagnosis is based on:


 * history (streptococcal tonsillitis, streptococcal pharyngitis, involvement of other organs in rheumatic fever);


 * physical examination (valve murmur, pericardial murmur, signs of heart failure);

laboratory tests ( CRP, FW, leukocytosis, ASLO antibodies);


 * ECG (AV block, non-specific ST changes);


 * transthoracic or transesophageal echocardiography.

Treatment

 * bed rest


 * intramuscularly Penicillin G, to which the depot form of penicillin binds


 * prednisone


 * acetylsalicylic acid