DIAGNOSIS
When diagnosing Rheumatic fever, it is important for the clinician to use the preexisting Jones criteria. An essential criteria for diagnosis would be the evidence of streptococcal infection. This can be obtained through a high or rising antistreptolysin-O (ASO) antibody titer, a positive throat culture for group A streptococci, or recent scarlet fever. Once the evidence of a streptococcal infection has been confirmed it would be important for the clinician to check for the major criteria. These would include carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules.
This would be done through assessment by assessing for chest pain, listening for the development of a previously undetected heart murmur, assessing the patients skin for rashes and/or nodules, as well as performing a neurological assessment to test for the development of chorea. Minor Criteria of for diagnosis of Rheumatic Fever include clinical symptoms such as arthralgias and fever, as well as increased C-reactive protein, WBC count, and erythrocyte sedimentation rate. An increase in all three of those labs indicate inflammation and they will all be elevated when cardiac and joint symptoms begin, however, these should only aid the healthcare provider in prognosis, and not diagnosis of acute rheumatic fever. On electrocardiographic imaging, a prolonged PR interval may be seen as well. In order to reach diagnosis, an essential criteria must be present as well as 2 major criteria, or 1 major and 2 minor criteria. (McCance & Huether, 2014)
TREATMENT
Eradicating the streptococcal infection using a 10-day course of antibiotics is the primary therapy for acute rheumatic fever. NSAIDs can be used to treat inflammation caused by carditis and
Antibiotics courtesy of https://www.enritsch.com/health/heart-circulatory-health/rheumatic-heart-disease
arthritis, but will not prevent complications. There is little evidence that anti-inflammatory drugs are effective in treating pericarditis. Serious pericarditis may require the administration of cardiac glycosides, diuretics, as well as maintaining bed rest. Occasional surgical repair of the damaged valves may be necessary for recurrent rheumatic fever and carditis. The disease process is said to be resolved when the murmur can not be heard anymore, major manifestations are no longer present, the patient no longer has a fever, and the ESR is within normal values. This process can take up to 6 months. (McCance & Huether, 2014)