What is rheumatic fever?

Rheumatic fever is an acute, systemic, inflammatory disease that occurs as a reaction to a recent streptococcal soft-tissue infection, most commonly pharyngitis.

How long does it take from the onset of rheumatic fever until mitral stenosis develops?

It can be as short as 2 years. Progression seems to be particularly rapid in developing countries, for reasons which are not entirely understood but could relate to the lack of appropriate penicillin treatment of rheumatic fever or nutritional factors.

List the Jones criteria.

The Jones criteria are guidelines for making the diagnosis of an initial attack of rheumatic fever. There is a high likelihood that the disease is present if there is supporting evidence of antecedent group A streptococcal infection (positive throat culture, positive rapid streptococcal antigen test, elevated or rising streptococcal antibody titer), as well as either two major or one major plus two minor manifestations.

Besides mitral stenosis, how does rheumatic disease affect the heart?

Aortic regurgitation is the second most common lesion, followed by mitral regurgitation and aortic stenosis. The tricuspid valve is less commonly involved, either with stenosis or regurgitation. Involvement of the pulmonary valve is rare. Constrictive pericarditis is thought not to be a sequela to rheumatic fever.

What are the typical symptoms of mitral stenosis?

Dyspnea on exertion is the classic presenting symptom. However, mitral stenosis can present with an arrhythmia, such as atrial fibrillation, or a systemic embolic event, since atrial thrombi are common in mitral stenosis.

What are less typical presentations?

Severe mitral stenosis can present as pulmonary edema or severe right-sided heart failure if pulmonary pressures become severely elevated. Approximately 15% of patients with mitral stenosis experience angina. Although this symptom may arise from right ventricular hypertension, concomitant atherosclerosis, or embolization of a left atrial thrombus to a coronary artery, in many cases the explanation for chest pain in mitral stenosis cannot be determined.

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