Podcasts about Rheumatic fever

Acute Sore Throat explained, including different causes including strep throat and peritonsillar abscess, with treatment of each. Also includes common associated symptoms as well as more worrying symptoms and a viral vs bacterial scoring system for acute sore throat. Consider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is a sore throat?0:30 Sore Throat Symptoms1:50 Tonsillopharyngitis / Acute Pharyngitis / Strep Throat4:34 Infectious Mononucleosis 5:37 Peritonsillar Abscess (Quinsy) 7:04 Parapharyngeal Abscess & Retropharyngeal Abscess8:42 EpiglottitisReferences:1. BMJ Best Practice (2024) “Acute Pharyngitis”. Available at https://bestpractice.bmj.com/topics/en-gb/5/2. Cheng, A.G - MSD Manual Pro (2024) “Tonsillopharyngitis”. Available at https://www.msdmanuals.com/professional/ear,-nose,-and-throat-disorders/oral-and-pharyngeal-disorders/tonsillopharyngitis#Symptoms-and-Signs_v9468593. Laura Sauve, A - Canadian Paediatric Society (2021) “Group A streptococcal (GAS) pharyngitis: A practical guide to diagnosis and treatment”. Available at https://cps.ca/en/documents/position/group-a-streptococcal4. Efi Mantzourani (2022) - “Characteristics of the sore throat test and treat service in community pharmacies (STREP) in Wales: cross-sectional analysis of 11 304 consultations using anonymized electronic pharmacy records”. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9780525/#:~:text=Acute%20sore%20throat%20is%20a%20common%20presentation%20in,GABHS%20and%20viral%20infections%20is%20less%20accurate.%2011 5. ENTSHO (2022) - “Acute Sore Throat”. Available at https://entsho.com/triage-acute-sore-throat6. Watkins, R - Geeky Medics (2024) - “Rheumatic Fever”. Available at  https://geekymedics.com/rheumatic-fever/7. Kenneth, M.K - MSD Manual Pro (2023) - “Infectious Mononucleosis”. Available at https://www.msdmanuals.com/professional/infectious-diseases/herpesviruses/infectious-mononucleosis8. Cheng, A.G - MSD Manual Pro (2024) - “Epiglottitis”. Available at https://www.msdmanuals.com/professional/ear,-nose,-and-throat-disorders/oral-and-pharyngeal-disorders/epiglottitisPlease remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. 

Welcome to PICU Doc on Call, a podcast dedicated to current and aspiring intensivists. I'm Pradeep Kumar coming to you from Children's Healthcare of Atlanta, Emory University School of Medicine, and I'm Rahul Damania from Cleveland Clinic Children's Hospital. We are two pediatric ICU physicians passionate about all things medical education in the PICU.Episode Overview: PICU.com call focuses on interesting PICU cases and management in the acute care Pediatric setting. In this episode, we discuss the case of an eight-year-old boy with chest pain, fatigue, and shortness of breath. This case presentation by Rahul highlights the complexity of pediatric care in the PICU.Case Presentation: An eight-year-old boy with up-to-date immunizations and no recent travel or pet exposure presented to the PICU with chief complaints of chest pain, fatigue, and decreased oral intake. His history over the preceding two weeks included a diminishing appetite, episodes of vomiting, and shortness of breath.On examination, he exhibited various cardiac findings, including a hyperdynamic left ventricle, murmurs, and a noted gallop. Abdominal and neurological findings were also concerning. Diagnostic studies revealed an enlarged heart, and sinus tachycardia with left ventricular hypertrophy, and echocardiography confirmed severe valvular and ventricular abnormalities.Laboratory Findings:Laboratory findings included elevated BNP, slightly elevated troponin, and elevated inflammatory markers (ESR and CRP). Strep throat culture was negative, but ASO and anti-DNAse B titers were markedly elevated. MRI confirmed multiple punctate infarctions, likely due to valvular heart disease.Diagnosis: Given the complex multisystem presentation, the child was admitted to the PICU for intensive monitoring and comprehensive management of this multisystem pathology. The working diagnosis is rheumatic fever.The episode is organized into three parts:Pathophysiology of Acute Rheumatic FeverApproach to Diagnosis and InvestigationsManagement and PreventionPathophysiology of Acute Rheumatic Fever: Acute rheumatic fever is an autoimmune disease initiated by a response to group A strep infection, primarily due to molecular mimicry. The streptococcal M protein has structural similarities with host proteins, leading to organ damage, especially in the heart.Epidemiology: Acute rheumatic fever is most prevalent in low to middle-income areas, affecting over 80% of cases. It mainly affects children between 5 to 14 years of age, and overcrowded households and limited healthcare access increase the risk. Globally, rheumatic heart disease affects millions of people annually and claims many lives.Jones Criteria for Diagnosis: The Jones criteria help diagnose acute rheumatic fever. For

Medical student aims to improve Canterbury healthcare for rheumatic fever patients.

Rheumatic fever rates are on the rise, and have now returned to pre-Covid levels. Despite other high income nations reducing or near eliminating rheumatic fever, New Zealand is still struggling to control the disease. Rheumatic fever is preventable, and Dr Rawiri McKree Jansen says the country has an obligation to eliminate the disease, which disproportionately affects Maori and Pasifika people. He says New Zealand must address over-crowding in homes, and how the health system reaches the most vulnerable. Susie Ferguson speaks to Dr Rawiri McKree Jansen, the chief medical officer at Te Aka Whai Ora, the Maori Health Authority.

In this episode, we review the high-yield topic of Rheumatic Fever from the Pediatrics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

This year, cases of an invasive bacterial infection are rising earlier than usual in the US, the UK and other countries across Europe. The group A Streptococcus bacteria - commonly known as Strep A - usually only causes mild illness. However, things have become severe in some cases, with several children dying in recent weeks.So, should we be worried? And what symptoms should we look out for to help us identify this illness in ourselves and our families?In today's episode, Jonathan is joined by world-leading expert on the subject: Shiranee Sriskandan is a professor of Infectious Diseases at Imperial College London whose scientific research focuses specifically on Strep A bacteria. Regular guest and ZOE co-founder Tim Spector also joins, and as one of the world's top 100 most cited scientists, Tim has been closely following infectious diseases in the community through the ZOE Health Study. If you want to boost your immune system by uncovering the right foods for your body, head to joinzoe.com/podcast and get 10% off your personalized nutrition program.Timecodes:00:00 Introduction00:10 Topic Introduction01:40 Quickfire Questions03:15 What is Strep?04:04 How common is Strep?05:02 Seasonality of Strep and symptoms in different climates05:30 What makes this year different?06:31 Can Strep make other illnesses worse?07:07 We've already seen signs of Strep rising over time, is this due to lockdown?09:36 How worried should we be about Strep infections?10:10 Group A Strep will often get better on its own11:07 The risk of rarer invasive infections is greater as the pool of cases increases11:59 Immune response to Strep A can increase chances of Rheumatic Fever13:35 What is Rheumatic Fever?14:59 What are the symptoms of Strep A16:53 How to treat Strep Throat18:12 What is the relationship between Strep A and Scarlet Fever18:53 Who gets Scarlet Fever and what are the symptoms?19:34 What are the distinguishing features between covid and other sore throats20:53 Do children get more fevers if they are younger?22:54 What to do if you think your child has strep throat24:01 Can you get rapid tests for Strep A?24:25 Why has Strep throat been seemingly more prominent in the US than the UK25:41 Different health services around the world and their respective responses to Strep27:36 Should we be testing and treating?30:15 What role does differing attitudes to healthcare play in this?32:02 Should we be cautious about using antibiotics for Strep A?33:51 What potential problems are there around antibiotics?36:00 Would a vaccine be the answer to stopping Strep in its tracks?38:41 Tim's top tips to boost your immunity this winter41:06 SummaryEpisode transcripts are available hereRead about Tim Spector's ZOE Health Study hereFollow ZOE on Instagram: https://www.instagram.com/zoe/Have an idea for a podcast? Contact Fascinate Productions to bring it to life.

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1.34 Rheumatic Fever   Cardiovascular system review for the USMLE Step 1 exam.

Kristin is joined by Dr Jerry Abraham Alex - a medical registrar from Western Australia. They take an indepth look at Rheumatic Fever and Rheumatic Heart Disease.

Dhineli Perera chats to infectious diseases specialist Anna Ralph about acute rheumatic fever and rheumatic heart disease. Who gets these conditions, how are they diagnosed, and how do we manage them?

Anthropologist and Child Health researcher, Dr Julie Spray joins us once again. Tonight she's taking a look at Rheumatic Fever - how it impacts children and what the best interventions are for them.

New Zealand is on the map with a world first breakthrough for rheumatic fever.  New data from the University of Otago has revealed that household overcrowding is a major risk factor for acute rheumatic fever and streptococcal infections of the skin.  The lead researcher is none other than a man who has kept us informed on COVID for the past two years - Professor Michael Baker.See omnystudio.com/listener for privacy information.

New research has found a strong link between strep skin infections and rheumatic fever. University of Otago researchers investigated how streptococcal infections of the throat and skin are the first steps of a "disease pathway" that ends in contracting the inflammatory disease. This research adds to other data about strep skin triggering rheumatic fever, which in turn can cause heart disease. Otago University Department of Public Health senior research fellow and co-author of the study Dr Julie Bennett spoke to Corin Dann.

Dr Angela Egan is a trained GP, now working in a highly specialised team undertaking major heart and lung surgery in Townsville. Angela is a passionate advocate of lifestyle medicine, health equity and climate action in her community. In fact, her determination for stronger changes in these areas has motivated Dr Egan to run as an independent candidate in the upcoming Australian federal election.Angela discusses the health and social issues facing regional, rural and remote areas and we learn more about Cardiovascular Disease and Rheumatic Heart Disease in Australia, noting the high Indigenous burden, which necessitates urgent and transformational change.In this episode we discuss:• Angela's background; from a career in the army to medicine, and now running for politics!• Her passion for preventative and lifestyle medicine principles and her work in the community encouraging this• Multiple factors that contribute to the health disparities still seen between Indigenous and non-Indigenous communities, and how we work towards closing that gap• Heart health primer: An overview on the prevention, treatment and management of both Cardiovascular Disease and Rheumatic Heart Disease• Food insecurity in rural and remote areas• The impacts of climate change on the social and environmental determinants of health• Angela's motivations for standing for the federal election and her policy prioritiesTo view all the links to the websites and documents, make sure you visit the show notes on our website. Don't forget to subscribe to this podcast, leave us a review and share this episode with your friends and family.Please support our work and enable us to deliver more content by buying us a coffee.

The parents of a young boy with rheumatic fever are urging adults, particularly in pacific communities, to take sore throats and rashes in children seriously. Around 33 percent of last year's cases were among pacific peoples. There is currently no vaccine, and if left untreated can lead to heart disease or death. RNZ Pacific's Lydia Lewis has more

The parents of a young boy with rheumatic fever are urging adults, particularly in pacific communities, to take sore throats and rashes in children seriously. Around 33 percent of last year's cases were among pacific peoples. There is currently no vaccine, and if left untreated can lead to heart disease or death. RNZ Pacific's Lydia Lewis reports.

Pasifika warned to be vigilant against Rheumatic Fever in children and teenagers.

Early warning lessons learned from aTonga's volcanic eruption and tsunami; Pasifika warned to be vigilant against Rheumatic Fever in children and teenagers; and New Zealand government is being urged to show regional leadership in upcoming negotiations for a global plastics treaty.

What exactly is rheumatic fever and how was it treated in Regency times? What's wrong with living in Westgate buildings? Learn the answers to these questions and more in this episode of My Cousin Jane.Support the show

A major scientific advance into rheumatic fever has found it can be caused by strep infections of both the throat and skin. Doctors already knew strep throat caused by group A streptococcus bacteria could lead to rheumatic fever, an auto-immune disease which disproportionately affects Maori and Pasifika children and teens and can lead to heart disease. But now, Otago University research has found a strep skin infection can also lead to rheumatic fever, Their research also found oral antibiotics have little effect on rheumatic fever rates. Dr Rawiri McKree Jansen runs the National Hauora Coalition's Mana Kidz school health programme in South Auckland, which has helped catch strep throats before they progress. He spoke to Morning Report.

A major scientific advance into rheumatic fever has found it can be caused by strep infections of both the throat and skin. Doctors already knew strep throat caused by group A streptococcus bacteria could lead to rheumatic fever, an auto-immune disease which disproportionately affects Maori and Pasifika children and teens and can lead to heart disease. But now, Otago University research has found a strep skin infection can also lead to rheumatic fever, Their research also found oral antibiotics have little effect on rheumatic fever rates. Dr Rawiri McKree Jansen runs the National Hauora Coalition's Mana Kidz school health programme in South Auckland, which has helped catch strep throats before they progress. He spoke to Morning Report.

$10 million has been set aside to develop a vaccine for strep-throat - a precursor to rheumatic fever and rheumatic heart disease. Last year more than a hundred people were hospitalised for the first time with rheumatic fever, mostly Māori and Pasifika children. New Zealand is one of the few developed countries to still have the preventable illness so prevalent in the community. Emma Hatton reports.

Congenital Heart defects,Endocarditis, Shocks, Rheumatic Fever, Kawasaki disease & Hematological diseases

Health Issues In NZ - Max and Abi - DMEC youth brings you health issues NZ is facing at the moment, Rheumatic Fever and tooth decay. Both are two large health issues ethnic communities and NZ as a whole is facing at the moment. Today we'll discuss what these problems are, who is most at risk and what is being done in NZ to combat them. Broadcast on OAR FM Dunedin oar.org.nz

Join is as we discuss the Pediatrics in Review Article "Acute Rheumatic Fever" (May 2021) where we review Group A Strep and its progression to ARF and Rheumatic Heart Disease (RHD) as well as the manifestations of these illness, management, and prevention.

This episode covers rheumatic fever.Written notes can be found at https://zerotofinals.com/paediatrics/rheumatology/rheumaticfever/ or in the rheumatology section of the Zero to Finals paediatrics book.The audio in the episode was expertly edited by Harry Watchman.

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER), we cover an important myth: the association of strep throat and rheumatic fever. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

Acute rheumatic fever is a rare multisystem disease caused by a delayed autoimmune response to a recent untreated or inadequately treated Group A streptococcus infection (mainly from “strep throat” but can also be from group a strep skin infections). The signs of acute rheumatic fever include: Arthritis Fever Carditis Rash Sydenham’s chorea Subcutaneous nodules Follow us on Instagram @yourekiddingrightdoctors Facebook: https://www.facebook.com/yourekiddingrightpod-107273607638323/ Our email is yourekiddingrightpod@gmail.com Make sure you hit SUBSCRIBE/FOLLOW so you don’t miss out on any pearls of wisdom and RATE if you can to help other people find us! (This isn’t individual medical advice, please use your own clinical judgement and local guidelines when caring for your patients)

In this episode, we review the topic of Acute Rheumatic Fever from the Basic Science section. --- Send in a voice message: https://anchor.fm/orthobullets/message

Endocarditis, Rheumatic Fever, Kawasaki disease and many more.

Former Auckland Blues player Matt Johnson had his career cut drastically short after he nearly died from the complications of rheumatic fever. Now he's fighting to stop others from getting disease that usually starts in childhood but can lead to heart damage and devastating life long consequences. He's working with the heatlh charity Cure Kids as it put a big chunk of funding into fighting the disease. Health correspondent Rowan Quinn and videographer Simon Rogers filed this report.

Yep we said it. We got a celebrity on the podcast. One and only Dr. Robert Centor joins us to chat all about pesky Acute Pharyngitis on the exam, why we need to worry more about suppurative complications than Rheumatic Fever, and HIV is more common than you think...

Resident Doctor Bryan Betty has been looking into the recent rise in rheumatic fever. LISTEN TO AUDIO ABOVE  

Through Joanne's amazing healing journey you will discover the inspirational way she went suffering from 4 different autoimmune diseases Rheumatic Fever, Hashimoto's Thyroid disease, Alopecia, and Mixed Connective Tissue Disorder to the state where she healed naturally from it. What she did on the way and how she deals with it today. Multiple Autoimmune Diseases Treatment Naturally | With Joanne Nottage And Functional Medicine - #12 Functional Medicine Healing Journeys - Episode #12 **Show Highlights:** - Who is Joanne [00:00] - What Joanne suffered from [00:00] - How did Joanne heal from Multiple Autoimmune Diseases [00:00] - What was the most helpful resource for Joanne [00:00] - What Joanne will tell a person that his in the same stage she was [00:00] - First recommended "baby step" [00:00] - Does Joanne's healing journey was worth it? [00:00] You will also learn about: - Multiple Autoimmune Diseases Treatment Naturally - Functional Medicine - The power of a positive thinking - Rheumatic Fever Symptoms And Natural Treatment - Hashimoto's Thyroid disease Symptoms And natural treatment - Alopecia Symptoms And natural treatment - Mixed Connective Tissue Disorder disease Symptoms And natural treatment - Multiple Autoimmune Diseases symptoms This episode is a must! To anyone who dealing with Multiple Autoimmune Diseases like Rheumatic Fever, Hashimoto's Thyroid disease, Alopecia, and Mixed Connective Tissue Disorder, and wants to learn about Multiple Autoimmune Diseases healing or anyone who looking to learn more about, Functional Medicine approach and the natural healing journey that Melanie did. ======================= I'm Dani Banai - A Functional Medicine Certified Health Coach And my mission is to make the world a healthier place! The purpose of this unique project is to inspire and give hope to people all over the world who suffering from chronic disease or chronic symptoms by sharing with them, personal healing journey of regular people who used Functional Medicine Approach ==== Our Facebook support group link: === https://www.facebook.com/groups/418870108861077/ =============== Show Notes ============== Website: https://danibanai.com/en/how-to-heal-from-multiple-autoimmune-diseases-naturally/ YouTube: https://youtu.be/nNqQd01Zviw =============== Disclamer =============== The information in this video is not intended as medical advice. In addition to searching the Internet for information related to Multiple Autoimmune Diseases natural treatment and health, please consider consulting with a qualified medical healthcare professional regarding Multiple Autoimmune Diseases cure, treatment, and symptoms

Doctors fear a rise in the potentially devastating childhood disease rheumatic fever could get worse as the effects of the Covid-19 lockdown hit. A public health alert has been issued for Wellington after a sudden spike in the number of children with disease there this year. But there could be more cases brewing that haven't yet come to light. Health correspondent Rowan Quinn reports.

There's been a dramatic spike in the number of Wellington children in hospital with the dangerous disease rheumatic fever. A public health alert has been issued, with Covid-19 testing centres ordered to swab any children at risk. Case numbers are up across the whole country, with the lockdown possibly a factor. RNZ's health correspondent Rowan Quinn reports.

There's been a big increase in the number of Wellington children in hospital with acute rheumatic fever. The region's public health service has issued an alert, telling doctors, emergency department and Covid-19 testing centres to be on the look out for the disease. There have been nine Wellington children hospitalised so far this year. Normally there would only be one or two. Nationwide, there's an increase of 25 percent. Rawiri Jansen is a Papakura GP and the clinical leader for the Maori general practice network the National Hauora Coalition. He told RNZ health correspondent Rowan Quinn it's a worry to see the disease on the rise.

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions:  Donna: Hello Dr. Cabral Team,I just had a consultation call with Erica and already sent an email of questions; I didn't want to over do it but I have just a few more. I'm about to start the CBO protocol and wanted to know if it is allowed to wash my greens in vinegar water if rinsed well? Also, is it okay to add pure cocoa powder to the morning nutritional support shake during the protocol?Respectfully, Donna C Monique: Hello, when I was 16, I was diagnosed with rheumatic fever- which enlarged my heart. However, my heart eventually went back to size. Fast forward to my early 30's where I was diagnosed with RA. I tried a lot of natural remedies including raw vegan but eventually it got so bad that I was hospitalized. Therefore, I saw a conventional doctor and have been on traditional RA meds since. Fast forward again to my 40s, a little after a year of having my first child, I was diagnosed with PH/PAH. I was told I have a lot of connective tissue that leans heavily on RA but I do have the RNP gene that connects Lupus to PH. With PH - in addition to pills, I have an IV drug that pumps into my heart 24/7. My question is, considering PH is a terminal condition that "doesn't have a cure" and it only affects 10% of people in the world, how can your program assist me?Thank you! Leah: I am a student of the IHP course. I am nearly done with level 1 and looking forward to level 2! I am a 42 yo mother of six with a history of EBV and early Hashimotos, which I healed through functional medicine testing and protocols. I continue to make gains in rebalancing my body one step at a time. My question for today (although I have so many!) is about oxalates. How do you manage high oxalate levels? Both my son and I have high oxalates as shown on our OATs. Are green supplement drinks a contributor to high oxalates levels, such as the fruit and vegetable blend or others? (I have used Newsun green drink in the past before I knew about Equilibrium Nutrition). Another son (17 yo), who has not had an OATs yet, and has small amounts of blood in the urine with no protein or other imbalances detected. Would the fruit and vegetable blend be ok for his kidneys, even if his oxalates are high? I have been told to compensate for high oxalate levels by avoiding high oxalate foods or to take calcium citrate when eating these foods, but I would rather rebalance without limiting so many foods or trying to sneak calcium citrate into everyone’s food who won’t swallow capsules, especially for an indefinite length of time. What can I do to improve the body’s ability to handle oxalates and in general lessen the stress on the kidneys? Bettina: Dear Stephen Cabral Thank you once again for great podcasts, love them :-)I just heard an old podcast of your (540), and you mention toothpaste and mouthwash.I was wondering if you have tried toothpowder from Primal Life Organics. If not, I hope that you will try it and give your opinion on it sometime in the future :-) Another brand for Oral care is Living Libations I would love to hear your opinion on these products as well. I thank you so much in advance :-)Best regards,Bettina Lynn: I work with people that will only use Standard Process supplements. How does the DNS and Standard Process compare? The argument is that Standard Process is food and you are not taking anything extra that you may not need. Thanks Paula: What are your thoughts on mangosteen powder? I’ve heard it’s an amazing superfood with numerous benefits! Michael: I definitely have onychomycosis and maybe even some slight tinea cruris, most likely from getting dressed from my infected nails. Could you please direct me where to regain my health? Much Thanks. Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community’s questions!  - - - Show Notes & Resources: http://StephenCabral.com/1569 - - - Get Your Question Answered: http://StephenCabral.com/askcabral   - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - -   Dr. Cabral’s Most Popular Supplements: > “The Dr. Cabral Daily Protocol” (This is what Dr. Cabral does every day!) - - - > Dr. Cabral Detox  (The fastest way to get well, lose weight, and feel great!) - - - > Daily Nutritional Support Shake  (#1 “All-in-One recommendation in my practice) - - - > Daily Fruit & Vegetables Blend  (22 organic fruit & vegetables “greens powder”) - - - > CBD Oil  (Full-spectrum, 3rd part-tested & organically grown) - - - > Candida/Bacterial Overgrowth, Leaky Gut, Parasite & Speciality Supplement Packages - - - > See All Supplements: https://equilibriumnutrition.com/collections/supplements  - - -   Dr. Cabral’s Most Popular At-Home Lab Tests: > Hair Tissue Mineral Analysis (Test for mineral imbalances & heavy metal toxicity) - - - > Organic Acids Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Thyroid + Adrenal + Hormone Test  (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Adrenal + Hormone Test (Run your adrenal & hormone levels) - - - > Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Omega-3 Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - > Stool Test (Use this test to uncover any bacterial, h. 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In this episode we cover the rest of the Cardiology chapter, including:- Electrocardiography (including regulation of blood pressure)- Pathology (Congenital Heart Disease, Atherosclerosis, Hypertension, Ischemic Heart Disease, Myocardial Infarction, Cardiomyopathies, Rheumatic Fever, Infective Endocarditis, Pericardial Disease, Vasculitides, as well as Cardiac and Vascular Tumors)- Pharmacology (Vasopressors, Vasodilators, Sympatholytics, Diuretics, Antiarrhythmics, Adensine, and Digoxin)Get a discount on best selling study resources from Elsevier ITB listeners can get 30% off of books like Crush Step 1, USMLE Step 2 Secrets, Netter’s Anatomy Coloring Book, and more! Head over to us.elsevierhealth.com/insidetheboards and use the code ITB30 at checkout.About the Crush Step 1 Podcast With a focus on teaching you to “think like a question writer”, InsideTheBoards is the leading producer of medical education podcasts. The Crush Step 1 podcast, the second collaboration between InsideTheBoards and Elsevier, features a totally free, audio optimized, complete narration of Crush Step 1: The Ultimate USMLE Step 1 Review by Ted O'Connell, Ryan Pedigo, and Thomas Blair. Crush Step 1 features up-to-date, easy-to-read (or listen to), high yield info on all the material tested on the exam with topics selected by a review board of current medical students and residents who scored in the 99th percentile on the USMLE Step 1. The Crush Step 1 podcast is the perfect companion for your dedicated prep time. InsideTheBoards Study Smarter Podcast Each year during the dedicated prep time we run a “Study Smarter Series for the USMLE Step 1 and COMLEX Level 1” on our Study Smarter Podcast with a focus exclusively on breaking down USMLE style questions. Click here to check it out on iTunes or visit our BRAND NEW Website ITB Audio Qbank and iOS Beta AppThe Audio Qbank by InsideTheBoards mobile app has both free and premium features and is available on both Android and iOS. To get started, first, create a Boardsinsider Account on our website insidetheboards.comFree Features All of our podcasts in one place organized into playlists for easy studying (also with less ads and exclusive content) Mindfulness meditations designed specifically for medical students A monthly offering of high yield content (questions dissections, audio qbank samples) available only on our mobile app. Early Access and exclusive content like a preview of the soon to be released "Crush Step 1" podcast and the "Inside ITB" podcast where we "get real" about the challenges of building ITB and the day to day behind the scenes stuff. Premium FeaturesSubscribe to an ITB premium account and get additional features Access to 500+ audio optimized board style practice questions in our Audio Qbank. The Step 1 version is powered by Exam Circle and the Step 2 Version is powered by OnlineMedEd. New questions added each month. High Yield Pharmacology (powered by Lecturio) with 100 of the top pharm questions you need to know for both Step 1 and Step 2 Audio Flashcards (coming soon) Our audio qbank is PERFECT for studying for the boards on the go. And we're adding content and improving it all the time. Learn more about the Audio Qbank by InsideTheBoards mobile app hereInsideTheBoards, Elsevier and their collaborators are not affiliated with the NBME, USMLE, COMLEX, NBOME or any professional licensing body. InsideTheBoards and its partners fully adhere to the policies on irregular conduct outlined by the aforementioned credentialing bodies.

I'm reading my internal medicine lecture notes on Acute Rheumatic Fever introduction including the etiology, pathogenesis, pathologic peculiarities on various tissues and clinical presentation.

How might a sore throat be linked to a hear problem? Are elevated toilet cisterns better at flushing the toilet? What's your take on aliens and the paranormal? What are diabetes and coeliac disease? Why does my husband yawn so much? And where do road corrugations come from? Join Dr Chris and CapeTalk 567's Melanie Rice to find out! Like this podcast? Please help us by supporting the Naked Scientists

How might a sore throat be linked to a hear problem? Are elevated toilet cisterns better at flushing the toilet? What's your take on aliens and the paranormal? What are diabetes and coeliac disease? Why does my husband yawn so much? And where do road corrugations come from? Join Dr Chris and CapeTalk 567's Melanie Rice to find out! Like this podcast? Please help us by supporting the Naked Scientists

My notes on reading about kawasaki disease and rheumatic fever

Healing From Rheumatic Fever and My Grandma's Experiences With God Would love to hear from you. Email: jordan@jordancpeterson.com Twitter: @411Jordan Website: http://jordancpeterson.com/

First day study for EOR exam. Get a quick synopses on Rheumatic Fever.

“Acute rheumatic fever is proceeded by an infection with Group A strep” is a mantra that all health care workers know. This episode digs through the history of how we came to understand this fact, as well as how our understanding of the pathophysiology and treatment of rheumatic fever developed. Intro :10 Why I made this episode :30 Outline of this episode 1:55 Rheumatic fever was really bad 3:10 The early 1700s 4:10 A big leap 6:15 The Jones criteria 11:07 History of the bacteriology 14:23 The heroic ASO titre 20:51 Rheuminations is powered by Healio 21:40 Another breakthrough: penicillin 21:51 Not all group A strep is the same 25:06 The decline of rheumatic fever 25:56 What about the host? 29:30 The joints 38:56 Summary 40:28 Never appreciated how bad rheumatic fever was 42:18 We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: A History of Medical Bacteriology and Immunology, First Edition, Butterworth-Heinemann, Oxford, 1970. Aspinall GO, et al. Infect Immun. 1994;62:2122-2125. Carapetis JR, et al. Nat Rev Dis Primer. 2016;doi:10.1038/nrdp.2015.84. Cox CJ, et al. J Immunol. 2013;doi:10.4049/jimmunol.1102592. Engel ME, et al. PLoS One. 2011;6:e25326. FW Denny, et al. JAMA. 1950;143:151-153. Gray LA, et al. J Infect Dis. 2017;216:1460-1470. Kaplan MH, et al. Lancet. 1962;1:706-710. Karthikeyan G, Guilherme L. Lancet. 2018;392:161-174. Khandke KM, et al. J Exp Med. 1987;doi:10.1084/jem.166.1.151. Paul O, et al. Clin Cardiol. 1990;13:367-369. Quinn A, et al. Infect Immun. 2001;69:4072-4078. Robertson KA, et al. BMC Cardiovasc Disord. 2005;5:11. Rojas Manuel, et al. J Autoimmun; 2018;95:100-123. Tandon R, et al. Nat Rev Cardiol. 2013;10:171-177.

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions:  Rosemary: Asking for help for all who have (what supplements etc.,) for Dupuytren's Contracture (this from the internet) is a common problem that develops most frequently after age 40. It is more common in men than women, though both can be affected. It is usually hereditary occurring in people of European and Western Asian ancestry. It is unusual in Oriental or African-Americans. Dupuytren's usually starts as a painless nodule in the palm. It can progress to fibrous cords extending into the fingers, most commonly ring and little. These bands can cause contracture of the fingers. It can progress slowly or rapidly. The flexor tendons are not affected. Kerry: Hi DR Cabral, What you you advise to support a 8 yr old how has had rheumatic fever and now has been prescribed daily antibiotics till their 21st birthday. Your advice is so appreciated Jason: I’m wondering what you recommend as a sun screen that’s not toxic to the body. I’m looking for something you can use multiple times a day with summer coming up.. thank you Aston: Hi Dr. Cabral, I know you like to like to talk about doing things that support the body’s natural detox process. Even with a good diet of mainly plant based foods with some fish and good exercise of Pilates and yoga, I still will wake up sometimes very bloated/puffy. I have been into using jade rollers, dry brushing and foam rolling to help out my lymphatic system and it does seem to help a bit. I was wondering if there was a way to prevent the puffiness and what your thoughts are on these “trendy” tools. Thanks! Katie: Hi Dr. Cabral! I’ve heard all your podcasts focused on estrogen dominance and your recommendations, but I was wondering if you could talk about low estrogen in women (who are too young to be going through menopause). Do you see this a lot in your practice? I’ve had extensive hormone testing done (both convention endocrinologist and integrative practioners) and my estrogen levels are consistently low, even when considering the e:progesterone ratio. I know you can’t make specific recommendations for me, but I was hoping you could spend some time discussing why this happens to some young women and what your suggestions are. What are the negative symptoms of low estrogen? How to balance these hormones? I think this would be really great for a lot of us struggling to find answers about our hormones when there is so much information out there is about pacifying too high of estrogen... but sometimes its the opposite issue! If you search up seed cycling for examples, so many articles and testimonials are about how it was aimed to cure their estrogen dominance and regulate their cycle. I know you mentioned that seed cycling could also help menopausal women with low estrogen, and that most women can benefit from it, but if you have any more to say on the topic (low estrogen in young women) I think there’s a lot of us who would love to hear your insights. side note: all other markers (cortisol, pituitary mri, FHS, thyroid) came back totally well and good. Haven’t had a period in 2 years, not on BC, on ultra sounds a lot of follicles present so I have been left with the “mild PCOS” diagnosis and very little options other than ‘not to worry’ because i will be able to have kids some day and that ‘there’s always the pill’ if I’m that concerned about mensturating regularly (which is definitely not an option for me ha). I have been really struggling with my health the past two years, so much so I had to take time off from college (academics are so important to me so this was a really big blow) and has had a huge impact on my mental and emotional help. I have been treated for parasites, eat a super healthy diet, and am currently following you CBO protocol. Without getting into EVERYthing I have tried and done (much like your journey, its been a wild ride), I guess I’m wondering if this hormonal imbalance really could all be related to stress and my emotional state (despite stress hormones being in normal range) that have resulted from all my gut and digestive issues. Thanks so much for all the information you share with us, I love learning as much as I possibly can to get to the bottom of this, and the podcast is so full of value, its truly amazing how much you offer free of charge. Thank you. best, Katie!   Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community’s questions!  - - - Show Notes & Resources: http://StephenCabral.com/1226 - - - Get Your Question Answered: http://StephenCabral.com/askcabral   - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - -   Dr. Cabral’s Most Popular Supplements: > “The Dr. Cabral Daily Protocol” (This is what Dr. Cabral does every day!) - - - > Dr. Cabral Detox  (The fastest way to get well, lose weight, and feel great!) - - - > Daily Nutritional Support Shake  (#1 “All-in-One recommendation in my practice) - - - > Daily Fruit & Vegetables Blend  (22 organic fruit & vegetables “greens powder”) - - - > CBD Oil  (Full-spectrum, 3rd part-tested & organically grown) - - - > Candida/Bacterial Overgrowth, Leaky Gut, Parasite & Speciality Supplement Packages - - - > See All Supplements: https://equilibriumnutrition.com/collections/supplements  - - -   Dr. Cabral’s Most Popular At-Home Lab Tests: > Hair Tissue Mineral Analysis (Test for mineral imbalances & heavy metal toxicity) - - - > Organic Acids Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Thyroid + Adrenal + Hormone Test  (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Adrenal + Hormone Test (Run your adrenal & hormone levels) - - - > Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Omega-3 Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - > Stool Test (Use this test to uncover any bacterial, h. 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Jane, Joyce, Minh talk about acute rheumatic fever for a couple of minutes. Hopefully along the way some worthwhile buzzwords and high yield principles are described.

Rheumatic fever rates are on the rise. Philippa Tolley talks to those living with this heart-damaging auto-immune disease and to those left behind.

Course: Review of Inflammatory Arthritis with HLH and MAS Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics Course Director: Elaine Cassidy. - Assistant Professor in the Dept of Pediatrics   Disclosures: None This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.  This episode is a Review of Inflammatory Arthritis with HLH and MAS. As always there is free CME credit of up to 1.25 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.  ______________________________________________________ Objectives: Upon completion of this activity, participants will be able to: Define three of the inflammatory arthritis – Rheumatic Fever, Reactive Arthritis and Juvenile Idiopathic Arthritis. Discuss the diagnostic criteria and treatment for each of the above arthritis. Discuss the differences between Macrophage Activation Syndrome and Hemophagocytic Lymphohistiocytosis ______________________________________________________ Released:  3/15/2019, Reviewed 3/15/2019, Expire: 3/15/2020 If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account: Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training: Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/app/learner/loadModule?moduleId=20456 Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1.25)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

A 28-year-old who man had rheumatic fever as a child comes to the physician’s office because of fatigue and dyspnea for the past four months

Stories connect us, help us learn, and help us better understand each other. Melanin Base Camp founder Danielle Williams taps into the power of storytelling to showcase the many different ways people of color and LGBTQ+ folks experience the outdoors. In this episode, we talk to Danielle and featured bloggers Nadia Mercado and Dr. Favia Dubyk. In interviewing Danielle, there’s a lot we could dig in to. She’s a skydiver and started “Team Blackstar Skydivers,” a community for skydivers of color. She’s third generation military. She’s coping with complications from Rheumatic Fever that have left her unable to run. She’s also one of the founding members of Diversify Outdoors, a coalition of social media influencers who share the goal of promoting diversity in outdoor spaces. Their website also hosts Teresa Baker’s Outdoor CEO Diversity pledge. For this episode, I want to highlight Danielle’s work with Melanin Base Camp and the power of storytelling, and in particular, the power of telling your own story and listening to the personal stories of others. Women featured in this episode: Danielle Williams, Nadia Mercado, and Dr. Favia Dubyk Hosted by Gale Straub In this episode you'll hear: About Danielle's early experiences running Nadia Mercado's article "I said I Wasn't Outdoorsy, but I Lied" and how we create stories about what is outdoorsy and what isn't The value of stories to help us understand people with different backgrounds and cultures How Danielle's chronic illness has changed her perspective Why Danielle started Melanin Base Camp to share the stories of people of color and the myriad of ways they experience the outdoors Why bloggers Nadia Mercado and Dr. Favia Dubyk contribute to Melanin Base Camp The power of storytelling to connect, to educate, and to create a historical record About Nadia's article, "Shut Up and Climb" and why 'good vibes only' cultures in outdoor adventure sports can be destructive What Melanin Base Camp will be focusing on in 2019 Sponsored by ThirdLove Join us in our She Explores Podcast Facebook Group Learn more at She-Explores.com Sponsor Website Head to ThirdLove.com/explore to learn more and get 15% off your first purchase! Resources Melanin Base Camp: Website, Instagram, Facebook Team Blackstar: Community for skydivers of color founded by Danielle Diversify Outdoors Nadia Mercado: Instagram Favia Dubyk: Instagram "I Said I Wasn't Outdoorsy, But I Lied" Shut Up and Climb Favia's Three Part Series on Cancer and Climbing: Part 1, Part 2, Part 3 Enjoy this episode? Rate us on Apple Podcasts or wherever you listen. It’ll help other people find us. Music is by Evan Schaeffer, Nihilore, Lee Rosevere, Miss, and Kai Engel using a Creative Commons Attribution license.

This podcast covers acute rheumatic fever, including the classification criteria, epidemiology and etiology, clinical presentations, differential diagnosis, investigations, and differences between primary and secondary management.  This podcast was developed by Mahabba Smoka, a medical student at the University of Alberta and Dr. Dax Rumsey, a Pediatric Rheumatologist at the University of Alberta and Stollery Children’s Hospital in Edmonton, Canada.

Discussion on the background, diagnosis and treatment of rheumatic fever - and also the public health aspects of the disease.

If you’re jonesing for some teaching on rheumatic fever, we’ve got the podcast for you.   Link dump: Clinical manifestations of rheumatic fever by time course  

Myocardial infarction (MI) in children is uncommon, but underdiagnosed.  This is due to two main factors: the etiologies are varied; and the presenting symptoms are “atypical”. We need a mental metal detector!  Case examples Congenital Two main presentations of MI due to congenital lesions: novel and known.  The novel presentation is at risk for underdiagnosis, due to its uncommonness and vague, atypical symptoms.  There are usually some red flags with a careful H&P.  The known presentation is a child with a history of congenital heart disease, addressed by corrective or palliative surgery.  This child is at risk for expected complications, as well as overdiagnosis and iatrogenia.  Risk stratify, collaborate with specialists. The fussy, sweaty feeder: ALCAPA Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is an example of what can go wrong during fetal development: any abnormality in the number, origin, course, or morphology of the coronary arteries can present as a neonate with sweating during feeds (steal syndrome), an infant in CHF, or an older child with failure to thrive or poor exercise tolerance. The stable child with chest pain: myocardial bridge Normal coronary arteries run along the epicardial surface of the heart, with projections into the myocardium.  If part of the artery’s course runs within the myocardium (i.e. the artery weaves into and/or out of the myocardium), then there is a myocardial bridge of the coronary artery.  With every systolic contraction, the artery is occluded.  Although a myocardial bridge may not cause symptoms (especially at distal portions), the area it supplies is at risk. With any minor trauma or exertion, demand may outpace supply, resulting in ischemia.  Diagnosis is made on coronary angiography. The unwell child post-cardiac surgery: Fontan problems The child with single ventricle physiology may have a Norwood procedure at birth (creation of a neoaorta, atrial septectomy, and Blalock-Taussig shunt), a Bidirectional Glenn procedure at 3-6 months (shunt removed, superior vena cava connected to pulmonary arteries), and a Fontan procedure at about 2-3 years of age (inferior vena cava blood flow is shunted into the pulmonary arteries). These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.  They are typically on an anticoagulant (often aspirin), a diuretic (e.g. furosemide), and an afterload reduction agent (e.g. enalapril).  Any disturbance in volume status (hyper- or hypovolemia), anticoagulation, or afterload may cause myocardial strain or infarction.  Take the child s/p Fontan seriously and involve his specialists early with any concerns. Autoimmune The body’s inflammatory-mediated reaction to a real or perceived insult can cause short- and long-term cardiac sequelae.  Find out how well the underlying disease is controlled, and what complications the child has had in the past. The red, hot, crispy, flaky child: acute Kawasaki disease Kawasaki disease (KD) is an acute systemic vasculitis, diagnosed by the presence of fever for five or more days accompanied by four or more criteria:  bilateral conjunctival injection, mucositis, cervical lymphadenopathy, polymorphous rash, and palmar or sole desquamation.  The criteria may occur (and disappear) at any time during the illness. Infants are under double jeopardy with Kawasaki Disease.  They are more likely to have incomplete KD (i.e. not fulfill strict criteria) and if they have KD, they are more likely to suffer the dangerous consequences of aneurysm formation (chiefly coronary arteries, but also brain, kidney).  Have a low threshold for investigation. Treatment includes 2 g/kg/day IVIG and high-dose aspirin (30-50 mg/kg/day) acutely, then low-dose aspirin (5 mg/kg/day) for weeks to months.  Regular and long-term follow-up with Cardiology is required. The aftermath: sequelae of Kawasaki disease The family and child with a history of KD may have psychological trauma and continuous anxiety about the child’s risk of MI.  Approximately 4.7% of children who were promptly diagnosed and correctly treated will go on to have cardiac sequelae. Children who have no detected cardiac sequelae by 8 weeks, typically continue to be asymptomatic up to 20 years later.  Smaller aneurysms tend to regress over time, especially those < 6 mm. Thrombi may calcify, or the lumen may become stenotic due to myofibroblast proliferation.  Children with any coronary artery dilatation from KD should be followed indefinitely. Giant aneurysms (≥8 mm) connote the highest risk for MI.  Parents often are concerned about recurrence, and any subsequent fever can be distressing.  There is a low rate of recurrence for KD: approximately 2%.  Infants who have coronary aneurysms are at the highest risk for recurrence. The older child with vague chest complaints and hypercoagulability: Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome Up to 15% of cases of SLE begin in childhood.  Adult criteria are used, with the caveat that the diagnosis of SLE in children can be challenging; many children only manifest a few of the criteria initially before going on to develop further systemic involvement. The Systemic Lupus International Collaborating Clinics (SLICC) revised the criteria in 2012.  The patient should have ≥4/17 clinical and/or immunologic criteria.  The clinical criteria are: acute cutaneous (malar); chronic cutaneous (discoid); oral; alopecia; synovitis; serositis; renal; neurologic; hemolytic anemia; leukopenia; or thrombocytopenia.  The immunologic criteria are: ANA; anti-dsDNA; anti-Sm; antiphospholipid; low complement; and/or Direct Coombs (in absence of hemolytic anemia).  At least one criterion should be clinical, and at least one should be immunologic.  Children with antiphospholipid syndrome (APS) may occur with or without SLE.  Patients are at risk for venous and arterial thrombi formation.  APS may also cause structural damage, such as valvular thickening and valvular nodes (Libman-Sacks endocarditis).  Mitral and aortic valves are at the highest risk. Although most children with chest pain will not have MI, those with comorbidities should be investigated carefully. Trauma Direct, blunt trauma to the chest can cause myocardial stunning, dysrhythmias, or an asymptomatic rise in Troponin I.  However, some children are at risk for disproportionate harm due to a previously unknown risk factor.  Clinically significant cardiac injury occurs in up to 20% of patients with non-penetrating thoracic trauma. The motor vehicle collision: blunt myocardial injury Direct trauma (steering wheel, airbag, seatbelt), especially in fast acceleration-deceleration injury, may cause compression of the heart between the sternum and the thoracic spine. Electrocardiography (ECG) should be performed on any patient with significant blunt chest injury.  A negative ECG is highly consistent with no significant blunt myocardial injury. Any patient with a new abnormality on ECG (dysrhythmia, heart block, or signs of ischemia) should be admitted for continuous ECG monitoring. Elevation in troponin is common, but not predicted.  A solitary elevated troponin without ECG abnormality is of unclear significance.  Author’s advice: obtain troponin testing if there is an abnormal ECG, more than fleeting suspicion of BCI, and/or the child will be admitted for monitoring. Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. The high-velocity object: coronary artery dissection or thrombus Direct trauma (e.g. MVC, baseball, high-velocity soccer ball) may cause damage to the left anterior descending artery or left circumflex artery, at the highest risk due to their proximity to the chest wall.  Thrombosis and/or dissection may result, often presenting in a focal pattern of ischemia on the ECG. Echocardiography may reveal valvular damage related to the injury, as well as effusion and ejection fraction.  Since there is often a need to investigate the coronary anatomy, percutaneous coronary intervention (PCI) is recommended. The minor trauma with disproportionate complaint: myocardial bridge As mentioned in the congenital section (above), a known variation of a coronary artery’s course involves weaving in and out of the myocardium, creating a baseline risk for ischemia.  Even minor trauma in a child with a myocardial bridge may cause acute thrombus, or slow stenosis from resulting edema.  Unfortunately, the presence of myocardial bridging is often unknown at the time of injury.  Approximately 25% of the population may have myocardial bridging, based on autopsy studies. Take the child seriously who has disproportionate symptoms to what should be a minor injury. Hematologic Coagulopathic and thrombophilic states may predispose children to focal cardiac ischemia.  The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. The child with sickle cell disease and chest pain: when it’s not acute chest syndrome Sickle cell disease (SCD) can affect any organ system, although the heart is traditionally considered a lower-risk target organ for direct sickling and ischemia.  The major cardiac morbidity in sickle cell is from strain, high-output failure and multiple, serial increases in myocardial demand, causing left ventricular hypertrophy and congestive heart failure. However, there is mounting evidence that acute myocardial ischemia in sickle cell disease may be underappreciated and/or attributed to other causes of chest pain. Other cardiac sequelae from SCD include pulmonary hypertension, left ventricular dysfunction, right ventricular dysfunction, and chronic iron overload. Evidence of myocardial ischemia/infarction in children with SCD has been demonstrated on single-photon emission computed tomography (SPECT) scan. The puffy faced child with chest pain: nephrotic syndrome hypercoagulability Children who suffer from nephrotic syndrome lose proteins that contribute to the coagulation cascade.  In addition, lipoprotein profiles are altered: there is a rise in the very low-density lipoproteins (LDL), contributing to accelerated atherosclerosis.  Typically nephrotic patients have normal levels of high-density lipoproteins (HDL), unless there is profuse proteinuria. Children with difficult-to-control nephrotic syndrome (typically steroid-resistant) may form accelerated plaques that rupture, causing focal MI, as early as school age. The previously well child now decompensated: undiagnosed thrombophilia Asymptomatic patent foramen ovale (PFO) is the cause of some cases of cryptogenic vascular disease, such as stroke and MI.  However, the presence of PFO alone does not connote higher risk.  When paired with an inherited or acquired thrombogenic condition, the venous thrombus may travel from the right-sided circulation to the left, causing distal ischemia.  Many of these cases are unknown until a complication arises. The chronically worried, now with a reason: hypercholesterolemia A family history of adult-onset hypercholesterolemia is not necessarily a risk factor for early complications in children, provided the child does not have the same acquired risk factors as adults (e.g. obesity, sedentary lifestyle, smoking, etc).  Parents may seek help in the ED for children with chest pain and no risk factors, but adult parents who have poor cholesterol profiles. The exception is the child with familial hypercholesterolemia, who is at risk for accelerated atherosclerosis and MI. Infectious Myocarditis has varied etiologies, including infectious, medications (chemotherapy agents), immunologic (rheumatologic, transplant rejection), toxins (arsenic, carbon monoxide, heavy metals such as iron or copper), or physical stress (electrical injury, heat illness, radiation). In children, the most common cause of myocarditis is infectious (viruses, protozoa, bacteria, fungal, parasites).  Of these, viral causes are the most common (adenovirus, enterovirus, echovirus, rubella, HHV6). The verbal child may complain of typical chest complaints, or may come in with flu-like illness and tachycardia or ill appearance out of proportion to presumed viral illness. The most common presenting features in children with myocarditis are: shortness of breath, vomiting, poor feeding, hepatomegaly, respiratory distress, and fever. The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’.  That may very well be true, but any virus can be invasive with myocardial involvement.  Infants are only able to increase their cardiac output through increasing their heart rate; they cannot respond to increased demands through ionotropy.  Look for signs of acute heart failure, such as hepatomegaly, respiratory distress, and sacral edema. The child with tachycardia out of proportion to complaint: myocarditis The previously healthy child with “a bad flu” may simply be very symptomatic from influenza-like illness, or he may be developing myocarditis.  Look for chest pain and tachycardia out of proportion to presumed illness, and constant chest pain, not just associated with cough. The “pneumonia” with suspicious chest x-ray: myocarditis Acute heart failure may mimic viral pneumonia.  Look for disproportionate signs and symptoms. Toxins Younger children may get into others’ medications, be given dangerous home remedies, take drugs recreationally, have environmental exposures (heavy metals), suffer from a consequence of a comorbidity (iron or copper overload) or have adverse events from generally safe medications. The hyperactive boy with a hyperactive precordium: methylphenidate Attention deficit hyperactivity disorder (ADHD) is growing in rate of diagnosis and use of medications.  As the only medical diagnosis based on self-reported criteria, many children are given stimulants regardless of actual neurologic disorder; with a higher proportion of children exposed to stimulants, adverse effects are seen more commonly. Methylphenidate is related to amphetamine, and they both are dopaminergic drugs.  Their mechanisms of action are different, however.  Methylphenidate increases neuronal firing rate.  Methamphetamine reduces neuronal firing rate; cardiovascular sequelae such as MI and CHF are more common in chronic methamphetamine use. Although methylphenidate is typically well tolerated, risks include dysrhythmias such as ventricular tachycardia. The child with seizure disorder and chest pain: anti-epileptics Some anti-epileptic agents, such as carbamazepine, promote a poor lipid profile, leading to atherosclerosis and early MI.  Case reports include school-aged children on carbamazepine who have foamy cells in the coronary arteries, aorta, and vasa vasorum on autopsy.  It is unclear whether this is a strong association. The spice trader: synthetic cannabinoids Synthetic cannabinoids are notoriously difficult to regulate and study, as the manufacturers label them as “not for human consumption”.  Once reports surface of abuse of a certain compound, the formula is altered slightly and repackaged, often in a colorful or mysterious way that is attractive to teenagers. The misperceptions are: are a) synthetics are related to marijuana and therefore safe and b) marijuana is inherently “safe”. Both tend to steer unwitting teens to take these unknown entities.  Some suffer MI as a result. Exposure to tetrahydrocannabinol (THC) in high-potency marijuana has been linked to myocardial ischemia, ventricular tachycardia, and ventricular fibrillation.  Marijuana can increase the heart rate from 20-100%, depending on the amount ingested. K2 (“kush 2.0”) or Spice (Zohai, Genie, K3, Bliss, Nice, Black Mamba, fake weed, etc) is a mixture of plant leaves doused in synthetic chemicals, including cannabinoids and fertilizer (JWH-108), none of which are tested or safe for human consumption.  Synthetic cannabinoids have a higher affinity to cannabinoid receptors, conferring higher potency, and therefore worse adverse effects.  They are thought to be 100 to 800 times more potent as marijuana. Bath salts (Purple Wave, Zoom, Cloud Nine, etc) can be ingested, snorted, or injected.  They typically include some form of cathinone, such as mephedrone, similar to the substance found in the naturally occurring khat plant. Hallucinations, palpitations, tachycardia, MI, and dysrhythmias have been reported from their use as a recreational drug. Chest pain with marijuana, synthetic cannabinoid, or bath salt ingestion should be investigated and/or monitored. Riding that train: high on cocaine Cocaine is a well-known cause of acute MI in young people.  In addition to the direct stimulant causes acutely, such as hypertension, tachycardia, and impaired judgement (coingestions, risky behavior), chronic cocaine use has long-term sequelae.  Cocaine causes accelerated atherosclerosis.  That, in conjunction with arterial vasospasm and platelet activation, is a recipe for acute MI in the young. Cranky: methamphetamine Methamphetamine is a highly addictive stimulant that is relatively inexpensive and widely available.  Repeated use causes multiple psychiatric, personality, and neurologic changes.  Risky behavior, violence, and motor vehicle accidents are all linked to this drug.  Like cocaine, methamphetamine may cause fatal dysrhythmias, acute MI from demand ischemia, and long-term sequelae such as congestive heart failure. Summary Acute MI is a challenging presentation in children: Easily missed: uncommon and atypical Varied etiology Respect vague symptoms with a non-reassuring H&P Try to detect it: CATH IT! References Congenital AboulHosn JA et al. Fontan Operation and the Single Ventricle. Congenit Heart Dis. 2007; 2:2-11. Aliku TO et al. A case of anomalous origin of the left coronary artery presenting with acute myocardial infarction and cardiovascular collapse. African Health Sci. 2014; 14(1): 23-227. Andrews RE et al. Acute myocardial infarction as a cause of death in palliated hypoplastic left heart syndrome. Heart. 2004; 90:e17. Canale LS et al. Surgical treatment of anomalous coronary artery arising from the pulmonary artery. Interactive Cardiovascaulr and Thoracic Surgery. 2009; 8:67-69. Güvenç O et al. Correctable Cause of Dilated Cardiomyopathy in an Infant with Heart Failure: ALCAPA Syndrome. J Curr Pediatr. 2017; 15:47-50. Hastings RS et al. Embolic Myocardial Infarction in a Patient with a Fontan Circulation. World Journal for Pediatric Congenital Heart Surgery. 2014; 5(4)L631-634. Hoffman JIE et al. Electrocardiogram of Anomalous Left Coronary Artery From the Pulmonary Artery in Infants. Pediatr Cardiol. 2013; 34(3):489-491. Kei et al. Rare Case of Myocardial Infarction in a 19-Year-Old Caused by a Paradoxical Coronary Artery Embolism. Perm J.2015; 19(2):e107-e109. Liu Y, Miller BW. ALCAPA Presents in an Adult with Exercise Inlerance but Preserved Cardiac Function. Case Reports Cardiol. 2012; AID 471759. Möhlenkamp S et al. Update on Myocardial Bridging.Circulation. 2002;106:2616-2622. Murgan SJ et al. Acute myocardial infraction n the neonatal period. Cardiol Young. 2002; 12:411-413. Sieweke JT et al. Myocardial infarction in grown up patients with congenital heart disease: an emergening high-risk combination. International Journal of Cardiology. 2016; 203:138-140. Schwerzmann M et al. Anomalous Origin of the Left Coronary Artery From the Main Pulmonary Artery in Adults. Circulation. 2004; 110:e511-e513. Tomkewicz-Pajak L et al. Arterial stiffness in adult patients after Fontan procedure. Cardiovasculr Ultrasound. 2014; 12:15. Varghese MJ et al. The caveats in the diagnosis of anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Images Paediatr Cardiol. 2010; 12(3): 3–8. Autoimmune Ayala et al. Acute Myocardial Infarction in a Child with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Turk J Rheumatol. 2009; 24:156-8. Nakano H et al. Clinical characteristics of myocardial infarction following Kawasaki disease: Report of 11 cases. J Pediatr. 1986; 108(2):198-203. Pongratz G et al. Myocardial infarction in an adult resulting from coronary aneurysms previously documented in childhood after an acute episode of Kawasaki’s disease. European Heart J. 1994. 15:1002-1004. Newburger JW et al.  Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease. A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110:2747-2771. Son MB et al. Kawaski Disease. Pediatr Rev. 2013; 34(4). Yuan S. Cardiac surgical procedures for the coronary sequelae of Kawasaki disease. Libyan J Med. 2012; 7:19796. Trauma Abdolrahim SA et al. Acute Myocardial Infarction Following Blunt Chest Trauma and Coronary Artery Dissection. J Clin Diagnost Res. 2016; 10(6):14-15. Galiuto L et al. Post-traumatic myocardial infarction with hemorrhage and microvascular damage in a child with myocardial bridge: is coronary anatomy actor or bystander. Signa Vitae. 2013; 8(2):61-63. Janella BL et al. Acute Myocardial Infarction related to Blunt Thoracic Trauma. Arq Bras Cardiol. 2006; 87:e168-e171. Liu X et al. Acute myocardial infarction in a child with myocardial bridge World J Emerg Med. 2011; 2(1):70-72. Long WA et al. Childhood Traumatic Infarction Causing Left Ventricular Aneurysm: Diagnosis by Two-Dimensional Echocardiography. JACC. 1985; 5(6):1478-83. Smith S. Right Bundle Branch Block after Blunt Trauma: A Tragic Case. [Blog Post] July 22, 2012. Retrievable at: http://hqmeded-ecg.blogspot.com/2012/07/right-bundle-branch-block-after-blunt.html. Hematologic Carano N et al. Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated with Heritable Thrombophilia. Pediatr. 2004; 114(2):255-258.      Chacko P et al. Myocardial Infarction in Sickle Cell Disease. J Cardiovascl Transl Res. 2013; 6(5):752-761. De Montalembert M et al. Myocardial ischaemia in children with sickle cell disease. Arch Dis Child. 2004; 89:359-362. Gladwin MT et al. Cardiovascular Abnormalities in Sickle Cell Disease. JACC. 2012; 59(13):1123-1133. Osula S et al. Acute myocardial infarction in young adults: causes and management. Postgrad Med J. 2002; 78:27-30. Silva JMP et al. Premature acute myocardial infarction in a child with nephrotic syndrome. Pediatr Nephrol. 2002; 17:169-172. Suryawanshi SP. Myocardial infarction in children: Two interesting cases. Ann Pediatr Cardiol. 2011 Jan-Jun; 4(1): 81–83. Infectious Cunningham R et al. Viral myocarditis Presenting with Seizure and Electrocardiographic Findings of Acute Myocardial Infarction in a 14-Month-Old Child. Ann Emerg Med. 2000; 35(6):618-622. De Vettten L et al. Neonatal Myocardial Infarction or Myocarditis? Pediatr Cardiol. 2011; 32:492-497. Durani Y et al. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009; 27:942-947. Erden I et al. Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza virus. Cardiol J. 2011; 552-555. Hover MH et al. Acute Myocarditis Simulating Myocardial Infarction in a Child. Pediatr. 1191; 87(2):250-252. Lachant D et al. Meningococcemia Presenting as a Myocardial Infarction. Case Reports in Critical Care. 2015; AID 953826. Laissy JP et al. Differentating Myocardial Infarction from Myocarditis. Radiology. 2005; 237(1):75-82. Miranda CH et al. Evaluation of Cardiac Involvement During Dengue Viral Infection. CID. 2013; 57:812-819. Rettig JS et al. Myocarditis in Children Requiring Critical Care Transport. In:  "Diagnosis and Treatment of Myocarditis", Milei J, Ambrosio G (Eds). DOI: 10.5772/56177. Toxins De Chadarévian JP et al. Epilepsy, Atherosclerosis, Myocardial Infarction, and Carbamazepine. J Child Neurol. 2003; 18(2):150-151. McIlroy G et al. Acute myocardial infarction, associated with the use of a synthetic adamantly-canabinoid: a case report. BMC Pharmacology and Toxicology. 2016; 17:2. Mir A et al. Myocardial Infarction Associated with Use of the Synthetic Cannabinoid K2. Pediatr. 2011; 128(6):1-6 Munk K et al. Cardiac Arrest following a Myocardial Infarction in a Child Treated with Methylphenidate. Case Reports Pediatr. 2015; AID 905097. Rezkalla SH et al. Cocaine-Induced Acte Mycardial Infarction. Clin Med Res. 2007; 5(3):172-176. Schelleman H et al. Methylphenidate and risk of serious cardiovascular events in adults. Am J Psychiatry. 2012 Feb;169(2):178-85. Sheridan J et al. Injury associated with methamphetamine use: a review of the literature. Harm Reduction Journal, 2006; 3(14):1-18. Stiefel G et al. Cardiovascular effects of methylphenidate, amphetamines and atomoxetine in the treatment of attention-deficit hyperactivity disorder. Drug Saf. 2010 Oct 1;33(10):821-42.   This post and podcast are dedicated to Edwin Leap, MD for his sanity and humanity in the practice of Emergency Medicine.  Thank you, Dr Leap for all that you do.

This is the audio recording of the study guide Rheumatic Fever, available here -> http://www.letstalkmed.com/rheumatic-fever.html . Facilitated and organized by Jinan AlRashoud

Rwanda Rusingiza, E Acute Rheumatic Fever Podcast 050616 by OPENPediatrics

In this podcast, Professor Ganesan Karthikeyan, the Editor-in-Chief of Heart Asia, interviews Dr Andrea Beaton about the 2015's revision of the Jones criteria for the diagnosis of acute rheumatic fever (ARF) and its major implications for practice in low-income and middle-income countries. Dr Andrea Beaton is the co-author with Jonathan Carapetis of this paper, accessible here: http://heartasia.bmj.com/content/7/2/7.full.

Dr Emma Best talks about sore throats and rheumatic fever.

Nick Brown talks to Suzanne T Anderson and Gabriella Watson, both Gambia Unit, Medical Research Council, about managing poststreptococcal complications, such as acute rheumatic fever and rheumatic heart disease, in resource-limited settings. Read the full paper: http://goo.gl/yFFW0f

Many doctors may believe that acute rheumatic fever is a disease of the past, but it's estimated that, worldwide, there are 500,000 new annual cases, and that 15 million have chronic rheumatic heart disease. Rachel Helena Webb, paediatric infectious diseases specialist at the Starship Children's Hospital in Auckland, joins us to discuss diagnosis and management of this condition. Read the full clinical review: http://www.bmj.com/content/351/bmj.h3443

Rheumatic fever for nurses and nursing students

Lois Williams looks at why New Zealand still has a high incidence of the third world disease: Rheumatic fever

Texas Heart Institute presents auscultation of mitral valve stenosis. Copyright 2009 by the Texas Heart Institute at St. Luke's Episcopal Hospital.