300.2 🩺 國考版

300.2.1 高頻考點

300.2.1.1 Jones Criteria 2015 AHA Modified

  • Major (CARDIAC): Carditis + Arthritis (migratory polyarthritis) + Sydenham chorea + Erythema marginatum + Subcutaneous nodules
  • Minor: fever, arthralgia, ↑ ESR/CRP, ↑ PR interval, prior ARF
  • Evidence of GAS: ASO, anti-DNase B, throat culture, scarlet fever

300.2.1.2 Subclinical Carditis (2015 Update)

  • Echo evidence of valvular involvement without auscultation findings
  • Now accepted in moderate/high-risk populations

300.2.1.3 Treatment

  • GAS pharyngitis primary: penicillin V 10 d OR BPG IM single dose
  • Acute ARF: ASA + NSAIDs (arthritis), steroids (severe carditis), bed rest, eradicate GAS
  • Secondary prophylaxis: BPG IM q3-4 wk OR pen V PO BID OR erythromycin/sulfa if allergic

300.2.1.4 Secondary Prophylaxis Duration

  • No carditis: 5 yr or to age 21 (whichever longer)
  • Mild carditis: 10 yr or to age 21
  • Severe carditis + RHD: lifelong (or age 40, varies)

300.2.1.5 Rheumatic Heart Disease

  • MS most common (rheumatic = 90% globally)
  • MR, AR, AS may co-exist
  • PMBV (Wilkins ≀ 8) for MS
  • Surgery for severe MR/AR/AS

300.2.1.6 Rheumatic Fever Mimics

  • Reactive arthritis (post-infectious)
  • SLE
  • Lyme disease
  • Endocarditis
  • Juvenile idiopathic arthritis

300.2.2 易混淆比范

Feature ARF Acute Endocarditis Lyme Carditis
Cause GAS pharyngitis S. aureus / others B. burgdorferi
Time 2-4 wk post Acute Days-weeks post
Carditis Pancarditis Vegetation/abscess AV block
Treatment ASA/NSAID + abx IV abx + surgery Doxy/ceftriaxone

300.2.3 Special Topics

300.2.3.1 Post-Strep Glomerulonephritis

  • Different syndrome from ARF
  • Skin infection (impetigo) or pharyngitis
  • 1-2 wk post infection
  • Hematuria, RBC casts, ↓ C3
  • Antibiotic doesn’t prevent

300.2.3.2 Migratory vs Symmetric Polyarthritis

  • ARF: migratory, asymmetric, large joints (knees, ankles, wrists)
  • RA: symmetric, small joints
  • Reactive arthritis: oligoarticular, asymmetric