Rheumatic Fever in Emergency Medicine Treatment & Management

Updated: Jan 04, 2017
  • Author: Steven J Parrillo, DO, FACOEP, FACEP; Chief Editor: Robert E O'Connor, MD, MPH  more...
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Treatment

Prehospital Care

Although no specific prehospital interventions exist for those with acute rheumatic fever, the patient's presentation may warrant establishment of intravenous access and placement of a cardiac monitor.

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Emergency Department Care

The emergency medicine physician's primary responsibilities are to suspect the diagnosis and to treat complications. Consider early administration of antibiotics.

Acute rheumatic fever (ARF) is usually preventable if antibiotics are initiated within 9 days of the onset of streptococcal infection. Remember, however, that most patients are not susceptible to developing ARF, even when infected with group A beta-hemolytic streptococci (GABHS).

The best approach to treating the patient with pharyngitis is beyond the scope of this discussion (see Pharyngitis).  However, the number needed to treat to prevent one case of ARF is estimated to be 100.

The controversy regarding the need to treat all cases of streptococcal pharyngitis is acknowledged. However, it remains true that appropriate treatment of such infection can and does prevent ARF. [30, 31]

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Consultations

Consider consulting a cardiologist, a rheumatologist, and a neurologist, for the following reasons:

  • Carditis is not only a major clinical finding, but is also the cause of much of the disability.
  • Arthritis is one of the major manifestations.
  • Movement disorders associated with acute rheumatic fever may be difficult to differentiate from those of other clinical problems.
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