What are the investigation procedures rheumatic heart disease

Laboratory Findings

There is no specific laboratory test to indicate the presence of rheumatic fever. The appraisal of rheumatic activity by laboratory finding is, however, of value.

Since various tests may indicate continued rheumatic inflammation when clinical features are not apparent. Streptococcal anti body test to disclose preceding streptococcal infection.

Streptococcal from other acute respiratory infections and are increased following asymptomatic as well as symptomatic streptococcal infection. These antibody levels are increased in the early stages of acute rheumatic fever.

They may be declining or low if the interval between the acute streptococcal infection and the detection of rheumatic fever has been longer than 2 months, a situation which occurs most often in patients whose presenting rheumatic manifestation is chorea.

However, patients whose only major manifestation is rheumatic carditis also may have low antibody titers when first seen. Their rheumatic attack may have been in progress several months before becoming symptolymatic and recognized.

Except in these two instances, one should be reluctant to make the diagnosis of acute rheumatic fever in the absence of serologic evidence of a recent streptococcal infection.

The antistreptolysin O (ASO) test is the most widely used and best-standardized streptococcal antibody test. In general, single titers of at least 250 Toadd units in adults and at least 333 units in children over 5 years of age are considered to be increased.

Depending on the general prevalence of streptococcal infections, a varying percentage of the normal population may shows titers of this magnitude.

About 20 percent of patients in the early stages of acute rheumatic fever, and most patients who present with chorea. Have a low or borderline ASO titer.

In these instances, it is advisable to obtain a different streptococcal antibody test such as anti-DNase B or antihyaluronidase (AH). The antistreptozyme (ASTZ) test is a hemagglutination reaction to a concentrate of extracellular streptococcal antigens absorbed to red blood cells.

It is a very sensitive indicator of recent streptococcal infection; virtually all patients with acute rheumatic fever have titers greater than 200 units per milliliter.

A rise in titer of two dilution tubes or more can be demonstrated for at least one of the specific streptococcal antibodies in almost all recurrent as well as primary attacks of rheumatic fever. Increased streptococcal antibodies.

However, do not reflect rheumatic activity per se, and their rate of decline is independent of the course of the rheumatic attacks. Because it almost always occurs within the first 4 to 5 weeks of the antecedent streptococcal pharyngitis.

Polyarthritis is the clinical manifestation most promptly recognized and therefore most reliably associated with rising streptococcal antibody titers.

The absences of increased or increasing streptococcal antibody titers in patients with acute polyarthritis therefore makes rheumatic fever a very unlikely cause.

Isolation of group A streptococci: Some patients continue to harbor group A streptococci at the onset of acute rheumatic fever, but these organisms are usually present in small numbers and may be difficult to isolate by a single throat culture.

The administration of penicillin or other antibiotics also may result in failure to isolate the infecting organism. In addition, a significant number of normal individuals, particularly children, may harbor group.

A streptococci in the upper respiratory tract. For these reasons, throat culture are less satisfactory than antibody test as supporting evidence of recent streptococcal infection,

Acute phase reactants: These tests offer objective but nonspecific confirmation of the presence of an inflammatory process. The erythrocyte sedimentation rate and the test for C- Reactive protein in serum are used most commonly.

Unless the patient has received glucocorticoids or salicylates, these reaction are almost always abnormal in patients presenting with polyarthritis or acute carditis, where as they are often normal in patients with “pure” chorea.

Other laboratory finding which reflect inflammation include reactions such as leukocytosis and increase in serum complement, mucoproteins, and alpha2 and gamma globulins.

Prolongation of the PR Interval of he electrocardiogram, although neither specific for rheumatic fever nor diagnostic of serious cardiac involvement, is frequent in acute rheumatic fever and other nonspecific electrocardiograpic changes are also common.

Anemia, due to the suppression of erythropoiesis characteristic of chronic inflammatory diseases, is another feature of rheumatic activity.

Table:

Investigation in Acute rheumatic fever indicated by three manifestations

Major Manifestations Percent

Carditis 14%

Polyarthritis 14%

Chorea 4%

Carditis and polyarthritis 44%

Carditis and Chorea 14%

Carditis, Chorea, polyarthritis 6%

Chorea and polyarthritis 4%
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Total 100%

 

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