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)

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.
 * skin (erythema marginatum, subcutaneous nodules).

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

Related articles

 * Rod Streptococcus: Streptococcus pyogenes
 * Streptococcal infection: Streptococcal infection group A • Scarlet fever • Spálová angína • Erysipelas • Impetigo
 * Non-infectious endocarditis • Infectional endocarditis