1)Complete Blood Count (CBC)
One may find leucocytosis with predominant polymorphonuclear cellular response in patients of ARF in presence of acute some throat.
2)Throat Culture
When patient presents as ARF, one should send throat swab for culture, however, positive throat cultures are uncommon (only 11 per cent). Certain rapid antigen detection kits are available which are specific but sensitivity is low.
3)Acute Phase Reactants
ESR and CRP are elevated in almost all patients of arthritis and carditis and rarely in patients with chorea. ESR should be repeated periodically as it is useful in following the course of disease as the level declines as the activity of the rheumatic process subsides.
4)Streptococcal Antibody Test
In about 80 per cent of ARF patients, ASO titre is significantly raised. ASO titres vary with age,geographical area and other fevers, which influence frequency of streptococcal infection. ASO titres are at peak usually 2-3 weeks after the streptococcal infection and fall rapidly in the next few months. Acute polyarthritis usually coincides with peak of ASO titre. Hence if ASO titre is normal in presence of arthritis, possibility of ARF is less. Anti-Dnase B and anti-hyaluro-nidase levels are important indicators of recent streptococcal infection.
5)X-ray Chest
It is helpful in assessing heart size. One should look for presence of pericarditis, pulmonary oedema or pulmonary congestion.
6)ECG
One should look for prolonged PR interval which is indicative of carditis. Also look for evidence of myocarditis in form of sinus tachycardia, QRST changes and AV block.
7)Echocardiography
It is very useful in diagnosis of carditis and rheumatic valvular heart disease. It can identify valvular regurgitation not picked clinically. It is useful to assess progress of rheumatic heart disease by serial echocardiography.
8)Endomyocardial Biopsy (EMB)
Endomyocardial biopsy helps in understanding that carditis can cause CCF in patients with rheumatic heart disease but frequency of diagnostic features on EMB is found only in 17 per cent cases, hence its routine use is not recommended.
One may find leucocytosis with predominant polymorphonuclear cellular response in patients of ARF in presence of acute some throat.
2)Throat Culture
When patient presents as ARF, one should send throat swab for culture, however, positive throat cultures are uncommon (only 11 per cent). Certain rapid antigen detection kits are available which are specific but sensitivity is low.
3)Acute Phase Reactants
ESR and CRP are elevated in almost all patients of arthritis and carditis and rarely in patients with chorea. ESR should be repeated periodically as it is useful in following the course of disease as the level declines as the activity of the rheumatic process subsides.
4)Streptococcal Antibody Test
In about 80 per cent of ARF patients, ASO titre is significantly raised. ASO titres vary with age,geographical area and other fevers, which influence frequency of streptococcal infection. ASO titres are at peak usually 2-3 weeks after the streptococcal infection and fall rapidly in the next few months. Acute polyarthritis usually coincides with peak of ASO titre. Hence if ASO titre is normal in presence of arthritis, possibility of ARF is less. Anti-Dnase B and anti-hyaluro-nidase levels are important indicators of recent streptococcal infection.
5)X-ray Chest
It is helpful in assessing heart size. One should look for presence of pericarditis, pulmonary oedema or pulmonary congestion.
6)ECG
One should look for prolonged PR interval which is indicative of carditis. Also look for evidence of myocarditis in form of sinus tachycardia, QRST changes and AV block.
7)Echocardiography
It is very useful in diagnosis of carditis and rheumatic valvular heart disease. It can identify valvular regurgitation not picked clinically. It is useful to assess progress of rheumatic heart disease by serial echocardiography.
8)Endomyocardial Biopsy (EMB)
Endomyocardial biopsy helps in understanding that carditis can cause CCF in patients with rheumatic heart disease but frequency of diagnostic features on EMB is found only in 17 per cent cases, hence its routine use is not recommended.
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