Rheumatic fever physical examination: Difference between revisions
Jump to navigation
Jump to search
Varun Kumar (talk | contribs) |
Varun Kumar (talk | contribs) No edit summary |
||
| Line 16: | Line 16: | ||
*[[Tachycardia]] | *[[Tachycardia]] | ||
*[[Jugular venous distension]] may be noted if the patient has [[congestive heart failure]] secondary to valvular | *[[Jugular venous distension]], [[S3|S<sub>3</sub>]] or occasionally a [[summation gallop]] may be noted if the patient has [[congestive heart failure]] secondary to valvular or [[myocarditis|myocardial involvement]]. | ||
*[[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>. | *[[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. | *[[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>. | **[[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. | **[[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. | ||
*[[Pericardial friction rub]] and low intensity [[heart sounds]] may be evident if [[pericardium]] is involved causing [[pericarditis]] and [[pericardial effusion|effusion]] respectively. | |||
===Respiratory examination=== | |||
*[[Epistaxis]] may be present in rheumatic fever if associated with severe [[carditis]]. | |||
*The lung fields may be dull on [[percussion]] in presence of [[infection]] or [[pleural effusion]] | |||
*[[Basilar crackles]] may be heard on [[auscultation]], which may be suggestive of [[pulmonary edema]] | |||
*[[Decreased breath sounds]] may be noted in presence of an accompanying [[pleural effusion]] | |||
===Abdominal examination=== | |||
[[Ascites]] may be observed if [[heart failure]] and fluid overload is present. | |||
===Extremities=== | |||
*[[Arthritis]] may be noted in 70-75% of patients. Often large joints of lower limbs (knee and ankle joints) and upper limbs (elbow and wrist joints) are involved progressing below-upwards. However, other small joints can also be affected<ref name="pmid16364469">{{cite journal| author=Olgunturk R, Canter B, Tunaoglu FS, Kula S| title=Review of 609 patients with rheumatic fever in terms of revised and updated Jones criteria. | journal=Int J Cardiol | year= 2006 | volume= 112 | issue= 1 | pages= 91-8 | pmid=16364469 | doi=10.1016/j.ijcard.2005.11.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16364469 }} </ref>. Arthritis in rheumatic fever is know to be migratory in nature and affecting multiple joints, persisting at each site for approximately one week. | |||
*Affected joints may be swollen, [[erythematous]], warm and tender, limiting the normal range of movement. | |||
*[[Pedal edema]] may be observed if [[congestive heart failure]] and fluid overload are present. | |||
==References== | ==References== | ||
| Line 29: | Line 44: | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:Rheumatology]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 05:00, 15 September 2011
|
Rheumatic fever Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Rheumatic fever physical examination On the Web |
|
American Roentgen Ray Society Images of Rheumatic fever physical examination |
|
Risk calculators and risk factors for Rheumatic fever physical examination |
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, S3 or occasionally a summation gallop may be noted if the patient has congestive heart failure secondary to valvular or myocardial involvement.
- 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.
- Pericardial friction rub and low intensity heart sounds may be evident if pericardium is involved causing pericarditis and effusion respectively.
Respiratory examination
- Epistaxis may be present in rheumatic fever if associated with severe carditis.
- The lung fields may be dull on percussion in presence of infection or pleural effusion
- Basilar crackles may be heard on auscultation, which may be suggestive of pulmonary edema
- Decreased breath sounds may be noted in presence of an accompanying pleural effusion
Abdominal examination
Ascites may be observed if heart failure and fluid overload is present.
Extremities
- Arthritis may be noted in 70-75% of patients. Often large joints of lower limbs (knee and ankle joints) and upper limbs (elbow and wrist joints) are involved progressing below-upwards. However, other small joints can also be affected[5]. Arthritis in rheumatic fever is know to be migratory in nature and affecting multiple joints, persisting at each site for approximately one week.
- Affected joints may be swollen, erythematous, warm and tender, limiting the normal range of movement.
- Pedal edema may be observed if congestive heart failure and fluid overload are present.
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.
- ↑ Olgunturk R, Canter B, Tunaoglu FS, Kula S (2006). "Review of 609 patients with rheumatic fever in terms of revised and updated Jones criteria". Int J Cardiol. 112 (1): 91–8. doi:10.1016/j.ijcard.2005.11.007. PMID 16364469.