RHEUMATIC FEVERANDRHEUMATIC HEART DISEASEDepartemen Kardiologi dan Kedokteran VaskularFK USUReumati! "e#er is an immunologi!all$ mediated in"lammator$ disease% tat o!!urs as a dela$ed se&uel to group A strepto!o!!al troat in"e!tion% in geneti!all$ sus!epti'le indi#iduals(Reumati! eart disease is te most serious !ompli!ation o" reumati! "e#erA!ute reumati! "e#er and reumati! eart disease are tougt to result "rom an autoimmune response% 'ut te e)a!t patogenesis remains un!lear IntroductionFuster V% et al( A!ute Reumati! Fe#er in Hurst te Heart *+t ed( Ne, -ork. M! /ra,Hill( 0++*( CausesReumati! "e#er is !aused '$ a group A strepto!o!!al( It o!!urs012,eekslatera"terpar$ngealin"e!tionina smallper!entageo"!ildrenaged31*3$ears(Itisan anti'od$1mediatedautoimmuneresponseando!!urs ,ereanti'odiesdire!tedagainst'a!terial!ell mem'raneantigens!ross1rea!tand!ausemultiorgan disease(Fuster V% et al( A!ute Reumati! Fe#er in Hurst te Heart *+t ed( Ne, -ork. M! /ra,Hill( 0++*(4atogenesisTe patogeni! me!anisms in#ol#ed in te de#elopment o" RF remainun!lear( 5ut it is e#ident tat an a'normal umoral and !ellular immune response o!!urs( Antigeni! mimi!r$ 'et,een strepto!o!!al antigens% mainl$ M1protein epitopes and uman tissues% su! as eart #al#es% m$osin and tropom$osin% 'rain proteins% s$no#ial tissue and !artilage(Mole!ular mimi!r$ ,as "irst demonstrated '$ umoral immune response( Strepto!o!!al anti'odies !ross1rea!t ,it se#eral uman tissues in!luding eart% skin% 'rain% glomerular 'asement mem'rane% striated and smootmus!les( Etiopathogenesis .6ones Criteria 70++2 Re#ision8 "or Diagnosis o" A!ute Reumati! Fe#erMajor manifestations*( Carditis0( 4ol$artritis2( Corea9( Er$tema marginatum3( Su'!utaneous nodules.Minor manifestations*( Fe#er 0( Artralgias2( 4re#ious reumati! "e#er or reumati! eart disease9( In!reased C1 rea!ti#e protein !on!entrations or ESR3( 4rolonged 4R inter#al on EC/.Evidence of antecedent group A streptococcal infection*( 4ositi#e troat !ulture or rapid antigen test positi#e "or group A strepto!o!!us0( In!reased or in!reasing strepto!o!!al anti'od$ titerReport of a WHO Expert Consultation Geneva Geneva !""#6ones Criteria 70++2 Re#ision8 "or Diagnosis o" A!ute Reumati! Fe#erA "irm diagnosis re&uires*8 0ma:or mani"estations or * ma:or and 0 minor mani"estationsand0 8 E#iden!e o" a re!ent strepto!o!!al in"e!tion(5lood test re#eal rising antistreptol$sin ; 7AST;8 titres ,en taken 0 ,eeks apart( Te troat s,a' ma$ 'e positi#e(Report of a WHO Expert Consultation Geneva Geneva !""#CarditisMio!arditis . resting ta!$!ardia% mu""led or so"t "irst eart sound% gallop r$tm% !ardiomegal$% or !ongesti#e eart "ailure( Endo!arditis 1 #al#ulitis . !anging murmur 7ne, api!al s$stoli! murmur o" mitral regurgitation and