Acute Rheumatic Fever and Rheumatic Heart Disease: Key Insights from Dr Allison Hempenstall

In this episode of The Good GP, host Dr Krystyna de Lange is joined by Dr Allison Hempenstall, a General Practitioner and Public Health Physician from Far North Queensland, to discuss acute rheumatic fever and rheumatic heart disease.

Dr Hempenstall begins by defining acute rheumatic fever as an immunological response to group A streptococcus, which can lead to a constellation of symptoms impacting the heart and joints. She explains the progression from acute rheumatic fever to rheumatic heart disease, a condition characterised by permanent valvular damage to the heart following of acute rheumatic fever.

Outlining the symptoms and diagnostic criteria for acute rheumatic fever, referencing the Jones criteria and the helpful tools available such as the Rheumatic Heart Disease Guidelines and the ARF and RHD app. She also provides insight into the criteria's major and minor manifestations, including carditis, polyarthritis, Sydenham’s chorea, Erythema marginatum, subcutaneous nodules, fever, elevated inflammatory markers, and prolonged PR interval on ECG.

Highlighting the necessary steps for diagnosing acute rheumatic fever, including auscultating the heart, documenting fever, performing a 12-lead ECG, and obtaining relevant blood tests. The need for bedside documentation and comprehensive differential diagnosis is also covered.

In terms of management, Dr Hempenstall focused on creating a culturally safe environment and initiating treatment for suspected acute rheumatic fever promptly. This includes administering intramuscular penicillin and managing symptoms with paracetamol, with specialist consultation as needed. She also stresses the importance of early echocardiograms and the involvement of public health units.

For long-term management, Dr Hempenstall discussed the necessity of secondary prophylaxis with penicillin injections and regular echocardiograms. She emphasises the continuing role of primary care practitioners in follow-up care, ensuring adherence to prophylaxis schedules, and coordinating ongoing specialist reviews and yearly dental checks.

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