CASE 1

An 11-year-old boy with complaints of headaches, palpitations, pain in the heart area, and
volatile arthralgias was admitted to the Rheumatology Department.
From the medical history, it was found out that two years ago, after suffering from scarlet
fever, he was hospitalized with polyarthritis, myocarditis. The diagnosis was interpreted as
primary rheumatic carditis. Etiotropic and pathogenetic therapy was performed. He was
discharged in a satisfactory condition. However, after discharge from the hospital, preventive
measures were not carried out.
The examination revealed signs of moderate endocarditis and myocarditis, symptoms of mitral
and aortic valve damage, and decompensation of blood circulation. In laboratory parameters:
ESR-47mm / hour, ASLO-1250 U, СRP (++++).
Clinical diagnosis:
Recurrent rheumocarditis, activity III, endomyocarditis, circulatory disorder 2A.Questions:

Questions:
1. Justify the diagnosis. What is the prognosis of the disease in this case?
2. Which groups of medications are currently indicated for this patient?
3. What will be the tactics of managing this patient after discharge from the hospital?

CASE 2

A girl of 13 years old suffered lacunar tonsillitis, soon after which her parents noticed
irritability, lability of mood and teachers at school noticed changes in her handwriting, and the
girl began to study worse. From an early age, the girl is often ill, has chronic tonsillitis (surgical
treatment was repeatedly offered).
On examination: asthenic constitution, pale skin, symptoms of chronic intoxication, increased
anterior-cervical and tonsillar lymph nodes. The gait is uncoordinated, the movements are
sweeping, the coordination of movements is broken. Quickly emotionally drains, grimaces.
No pathology was detected on the part of internal organs physically or during the instrumental
examination. General and biochemical blood tests without deviations from the norm.

Questions:
1. What is the most likely diagnosis in this case?
2. Therapeutic tactics of this form of the disease.
3. Prophylaxis

CASE 3

A 5-year-old boy was examined by a doctor 2 weeks after suffering from ARI due to the
presence of weakness, rapid fatigue, shortness of breath when walking. The child is pale, there
is perioral cyanosis. Pulse-130 per minute, blood pressure-90/45 mm Hg., breath rate -35 per
minute. Apex beat is spread and weakened. The right cardiac border -along the right
parasternal line, the upper - 2d rib, the left - 2.5 cm outside of the left mid-clavicular line. The
heart tones are significantly muted, a three-part rhythm is heard at the apex, a systolic
murmur. The liver protrudes from under the edge of the costal arch by 2 cm.
Questions:
1. Diagnosis?
2. What studies are necessary to confirm the diagnosis?
3. What therapeutic tactics should be implemented in this case?
ANSWERS

Case1 - acquired heart valvular disease after acute rheumatic fever (absence of preventive
measures).
Case 2- acute rheumatic fever (the only manifestation is chorea).
Case 3 - acute viral myocarditis after acute respiratory viral infection.