Date:
Patient:
Reason for Visit:
Follow-up for rheumatic fever (RF)
Assessment of symptoms and disease activity
Evaluation for complications (e.g., carditis)
Management plan discussion
History:
Presenting Illness:
Date of initial RF diagnosis
Signs and symptoms at presentation (e.g., fever, polyarthritis, carditis)
Current symptoms and any changes since last visit
Past Medical History (PMH):
Prior episodes of RF (if any)
Underlying medical conditions (e.g., strep throat)
Social History:
Recent history of streptococcal infection (especially pharyngitis)
Physical Exam:
General: Assess for signs of fever, fatigue, and joint swelling.
Musculoskeletal: Evaluate for tenderness, swelling, redness, and warmth in affected joints (typically large joints like knees, ankles, elbows, wrists). May document specific joint involvement.
Cardiac: Evaluate for heart murmurs (suggestive of carditis) and signs of heart failure (if present).
Diagnostic Tests (may be ordered depending on clinical presentation):
Laboratory Tests:
Acute phase reactants: Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) suggestive of inflammation.
Anti-streptococcal antibodies: Tests like antistreptolysin O (ASO) titer to confirm recent streptococcal infection.
Electrocardiogram (ECG): May show abnormalities suggestive of carditis (e.g., prolonged PR interval).
Echocardiogram: Evaluate for valvular involvement (e.g., mitral regurgitation) and signs of heart dysfunction.
Imaging Studies (may be used in some cases):
X-rays of affected joints: May show joint effusion but not specific for RF.
Assessment:
Disease activity: Based on clinical presentation, laboratory tests (inflammatory markers), and imaging findings.
Presence of carditis: Evaluate for cardiac symptoms, ECG abnormalities, and echocardiogram findings.
Risk of complications: Consider risk of carditis and long-term rheumatic heart disease.
Plan:
Antibiotic treatment: Penicillin or amoxicillin to eradicate streptococcal infection and prevent further immune response.
Anti-inflammatory medications: Medications like aspirin or corticosteroids to reduce inflammation and joint pain.
Cardiac management: If carditis is present, medications and monitoring may be needed based on the severity (consult with cardiology).
Prophylaxis: Long-term penicillin prophylaxis to prevent recurrent streptococcal infections and further episodes of RF.
Patient education: Provide information about RF, the importance of completing antibiotic treatment, and adherence to medications.
Discuss potential complications and the importance of reporting any worsening symptoms or new cardiac symptoms (chest pain, shortness of breath).
Emphasize the importance of good dental hygiene to prevent streptococcal infections.
Follow-up:
Schedule for follow-up appointments based on disease activity:
More frequent visits during initial treatment phase and if carditis is present.
Less frequent visits for patients with controlled disease and no carditis.
Monitor inflammatory markers (ESR, CRP) to assess response to treatment.
Repeat echocardiogram if carditis is present to monitor for improvement.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of rheumatic fever