ARF and Carditis

Q: 24 years old female is admitted to ICU with chest pain and shortness of breath. ECHO showed acute mitral regurgitation. Patient was subsequently found to have carditis associated with acute Rheumatic fever (ARF). Carditis in ARF is usually? (select one)

A) pericarditis

B) epicarditis

C) myocarditis 

D) endocarditis

E) pancarditis 

Answer: E

The usual acute cardiac presentation of ARF is mitral regurgitation (MR). It may also present as aortic regurgitation (AR). Clinical history with the presence of murmurs can be diagnostic. In MR, Carey Coombs murmur is classic. This murmur can be heard as a short mid-diastolic murmur loudest at the apex.

The carditis in ARF is usually pancarditis involving pericardium, epicardium, myocardium, and endocardium along with valvulitis. Said that any form of carditis i.e., choices A, B, C, and D may occur independently.

An echocardiogram is indicated as subclinical carditis can occur with high frequency and can be highly damaging.

#rheumatology

#cardiology

References:

1. Gewitz MH, Baltimore RS, Tani LY, et al. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: A scientific statement from the American Heart Association. Circulation 2015; 131:1806.

2. Fabi M, Calicchia M, Miniaci A, Balducci A, Tronconi E, Bonetti S, Frabboni I, Biagi C, Bronzetti G, Pession A, Donti A, Lanari M. Carditis in Acute Rheumatic Fever in a High-Income and Moderate-Risk Country. J Pediatr. 2019 Dec;215:187-191. doi: 10.1016/j.jpeds.2019.07.072. Epub 2019 Oct 3. PMID: 31587860.

3. Sika-Paotonu D, Beaton A, Raghu A, et al. Acute Rheumatic Fever and Rheumatic Heart Disease. 2017 Mar 10 [Updated 2017 Apr 3]. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes : Basic Biology to Clinical Manifestations [Internet]. Oklahoma City (OK): University of Oklahoma Health Sciences Center; 2016-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425394/