Rheumatic fever physical examination
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- Normotension or Hypotension (if pericardium is involved)
- Tachypnea (if heart valves, pericardium or myocardium are involved leading to cardiac dysfunction)
- Erythema marginatum is a pink-red rash frequently located on trunk, limbs, and seldom on the face, appearing as non-pruritic macules or papules extending centrifugally outwards with central clearing and raised outer margins
- Ruddiness of the skin secondary to rheumatic vasculitis
- Jugular venous distension, S3 or occasionally a summation gallop may be noted if the patient demonstrates congestive heart failure secondary to valvular or myocardial involvement
- Parasternal heave
- Cardiac murmurs if heart valves are involved; commonly regurgitant murmurs in acute rheumatic fever and valve stenosis in chronic rheumatic fever, and include:
- Pericardial friction rub and low intensity heart sounds (if pericarditis or pericardial effusion are involved)
- Dull on percussion in presence of pleural effusion
- Decreased breath sounds may be noted in presence of an accompanying pleural effusion
- Basilar crackles may be heard on auscultation, suggestive of pulmonary edema
- Sydenham's chorea (St. Vitus' dance, occurring very late in the disease for at least three months from onset of infection; see video #1)
- Spooning sign (flexion of the wrists and extension of the ﬁngers when the hands are extended)
- Pronator sign (turning outwards of the arms and palms when held above the head)
- Inability to maintain protrusion of the tongue
- Milk maids sign (intermittent increase and decrease of hand grip pressure; see video #2)
- Arthritis, often large joints of lower limbs (knee and ankle joints) and upper limbs (elbow and wrist joints), and can be migratory in nature, affecting multiple joints at one time
- Affected joints may be swollen, erythematous, warm, and tender
- Subcutaneous nodules in approximately 10% of rheumatic fever patients, usually appearing on extensor surface of limbs, and over bony prominences such as elbows, knees, ankles and knuckles, and are generally painless
- Pedal edema possible if congestive heart failure and hypervolemia are present
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- Ferrieri P, Jones Criteria Working Group (2002). "Proceedings of the Jones Criteria workshop". Circulation. 106 (19): 2521–3. PMID 12417554.
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- Olgunturk R, Canter B, Tunaoglu FS, Kula S (2006). "Review of 609 patients with rheumatic fever in terms of revised and updated Jones criteria". Int J Cardiol. 112 (1): 91–8. doi:10.1016/j.ijcard.2005.11.007. PMID 16364469.