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14 out of 16

NOT true about ASO titre: (AIIMS Nov 2009)

A May be positive in normal people

B Major Jones' criteria

C May be negative in post streptococcal GN

D May not be elevated even in presence of Carditis

Ans. B

Major jones criteria

Erythema marginatum (Ref. Hari-18th ed., pg 2754)

1. It is the transient pink ring shaped macule on the trunk and inner surfaces of the limbs.

2. It is found primarily on extensor surfaces

3. The rings are barely raised and are non-pruritic.

4. The face is generally spared.

Subcutaneous nodules:

They are small, Pea size nodules, non-tender and are mainly found on the extensors side of the bony prominent. Particularly of the hand, feet, elbows, occiput.

Evidence of a Preceding Group a Streptococcal Infection

1. With the exception of chorea and low-grade carditis, both of which may become manifest many months later, evidence of a preceding group A streptococcal infection is essential in making the diagnosis of Acute Rheumatic Fever (ARF).

2. As most cases do not have a positive throat swab culture or rapid antigen test, serologic evidence is usually needed.

3. The most common serologic tests are the anti-streptolysin O (ASO) and anti-DNase B (ADB) titers.


Hallmark is McCallum patch.

Patient may have Aschoff’s nodule which has Anitschkow myocyte.

Important points: (Pathology of rheumatic fever)

1. Aschoff nodules

2. McCallum patch

3. Fibrinous pericarditis


1. Benzylpenicillin 0.6-1.2g IM stat then penicillin V 250mg/6h orally

2. Analgesic for carditis/arthritis. Aspirin 100 mg/kg/d in divided doses. For 6wks. Toxicity causes tinnitus, hyperventilation, Metabolic acidosis

3. Steroids Q. Are specially used if carditis is there with or without CHF.

4. Valproate, carbamazepine for the chorea

Secondary prophylaxisPenicillin V 250mg/12h PO until no longer at risk (>30yr Alternative: sulfadiazine, erythromycin.

Table 322-3 American Heart Association Recommendations for Duration of Secondary Prophylaxis*

(Ref. Hari-18th ed., Pg- 2757,Table 322-3)

Category of Patient

Duration of Prophylaxis

Rheumatic fever without carditis

For 5 years after the last attack or 21 years of age (whichever is longer)

Rheumatic fever with carditis but no residual valvular disease

For 10 years after the last attack, or 21 years of age (whichever is longer)

Rheumatic fever with persistent valvular disease, evident clinically or on echocardiography

For 10 years after the last attack, or 40 years of age (whichever is longer). Sometimes lifelong prophylaxis.

Extra Edge:

1. Surgical replacement of mitral and/or aortic valve during acute rheumatic fever results in a rapid control of CCF and decrease in heart size, despite investigational evidence for ongoing active rheumatic fever. (AIIMS May 08)

2. The surgical findings thus indicate that it is the acute hemodynamic overload secondary to valvar regurgitation, which is responsible for CCF and the morbidity and mortality of acute rheumatic.

Other important conditions associated with streptococcal infection.

1. Post streptococcal reactive arthritis.

2. PANDAS (Pediatrics autoimmune neuropsychiatry disorder associated with Streptococci)

Cardiology Flashcard List

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