NurseSavvy Cheat SheetDisease
Rheumatic Fever
Pathophysiology & Risk Factors
Acute rheumatic fever is not an infection of the heart or the joints — it is an immune reaction to an infection that has already resolved. Two to four weeks after an untreated group A streptococcal throat infection, antibodies raised against the bacterium cross-react with the body's own connective tissue. The inflammation lands in the joints, the skin, the basal ganglia and the heart. Everything except the heart heals completely. Because the throat infection is long gone by the time symptoms appear, a negative throat culture does not rule the disease out.
Signs & Symptoms
EarlyProgresses →
migratory joint pain and swelling Hallmark
moves from joint to joint rather than staying in onefever
new heart murmur Hallmark
carditis — the only manifestation that can leave permanent damagechest pain and shortness of breath
fatigue and pallor
Late / Severe
Sydenham chorea Hallmark
jerky, purposeless movements and emotional lability — often mistaken for misbehaviourpainless nodules over bony prominences
flat pink rash with clear centres on the trunk
Interventions & Priorities
listen for a new or changing murmur every shift Hallmark
carditis is what determines the child's futureeradicate the streptococcus with penicillin Hallmark
rest during the acute inflammatory phase
position and handle painful joints gently
pad the bed and supervise a child with chorea
the movements are involuntary and can cause injurymonitor for signs of heart failure
arrange echocardiography
Treatments & Medications
penicillin Hallmark
clears any remaining streptococcuslong-term prophylactic penicillin Hallmark
continues for years to prevent a second attackaspirin or another anti-inflammatory
for the joint pain and fevercorticosteroids
when carditis is severeheart failure medication
if the valve damage causes failurePatient Teaching
finish every dose of antibiotic for a strep throat Hallmark
this is what prevents rheumatic fever in the first placeprophylactic penicillin continues for years, not weeks Hallmark
tell every dentist and surgeon about the valve damage
the chorea is involuntary and will pass
have any sore throat swabbed
keep cardiology follow-up appointments
Report Nowescalate immediately
a new murmur or a murmur that has changed Hallmark
shortness of breath or a night cough
developing heart failurechest pain
new jerky movements or a sudden change in handwriting
chorea appearingreturn of fever and joint pain Hallmark
a second attack damages the valve furtherClinical Pearl
The joints hurt and get better; the heart valve gets damaged and stays that way. Finish the antibiotics for strep throat and none of it happens.