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Rheumatic Heart Disease I: Introduction

Rheumatic Heart Disease I: Introduction

Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...

Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies

Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies

The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...

Rheumatic Heart Disease III: Medical Management

Rheumatic Heart Disease III: Medical Management

Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...

Pericarditis II: Clinical Features and Diagnostic Tests

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Myocarditis II: Clinical Features and Diagnostic Tests

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Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...

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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...

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Streptococcal Pharyngitis Complicated by Clinically Significant Rheumatic Myopericarditis: A Case Report.

Amanda Nguyen¹, Garrett Cohen², Matthew Lam³

¹Department of Medicine, University of California Davis Medical Center, Sacramento, USA.

Journal of Investigative Medicine High Impact Case Reports

|July 31, 2025

Summary

Acute rheumatic fever (ARF) can cause heart inflammation, even in adults. Early diagnosis and antibiotic treatment are crucial for preventing severe cardiac complications and ensuring recovery.

Keywords:

acute rheumatic fever case report myopericarditis prevention streptococcal pharyngitis

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Published on: September 24, 2021

Area of Science:

Cardiology
Infectious Diseases
Rheumatology

Background:

Acute rheumatic fever (ARF) is a sequela of streptococcal pharyngitis.
Cardiac involvement, including myocarditis and pericarditis, can occur in ARF.
While ARF prevalence has decreased, sporadic cases and outbreaks persist.

Purpose of the Study:

To report a case of rheumatic myopericarditis in an adult patient.
To highlight the importance of considering ARF in patients with cardiac symptoms following pharyngitis.
To emphasize the role of timely diagnosis and management in ARF-related cardiac complications.

Main Methods:

Case report of a 60-year-old male presenting with pharyngitis and subsequent cardiac symptoms.
Diagnostic workup included laboratory tests (inflammatory markers, cardiac enzymes, ASO titers), electrocardiogram, echocardiogram, and blood cultures.
Management involved pericardial drainage, medical therapy for heart failure and pericarditis, and antibiotic treatment for ARF.

Main Results:

The patient presented with sore throat, later developing chest pain and dyspnea.
Laboratory findings revealed elevated inflammatory markers, cardiac enzymes, positive ASO titers, and Streptococcus pyogenes bacteremia.
Diagnosis of rheumatic myopericarditis was confirmed, with pericarditis, effusion, and reduced systolic function.
The patient recovered cardiac function following treatment.

Conclusions:

Rheumatic myopericarditis is a rare but serious complication of streptococcal pharyngitis that can affect adults.
Clinicians should maintain a high index of suspicion for ARF in patients with cardiac manifestations, even without a history of rheumatic heart disease.
Prompt diagnosis, appropriate antibiotic therapy, and management of cardiac involvement are essential for favorable outcomes in ARF.