Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD)

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Acute rheumatic fever (ARF) is defined by Mosby (2010) as a systemic inflammatory disease which is enabled development with inadequate treatment of upper respiratory tract infections of group A beta-hemolytic streptococci. Repeated episodes of ARF can cause autoimmune reactions within the heart which in turn inflicts damage upon the heart muscle and heart valves, a condition termed as rheumatic heart disease (RHD) (Mosby, 2010). Predominately ARF and RDH cases are found to effect people living in developing countries. Steer and Carapetis (2009), have linked this issue with the lowered socioeconomic conditions, household crowding, inadequate health care and poor hygiene. In comparison both ARF and RHD have virtually been eliminated in industrialized countries (Steer & Carapetis, 2009). It is therefore of significant concern that indigenous populations of New Zealand still remain highly effected by ARF and RHD, potentially affecting 1 in 3 Maori and Pacific children with significant morbidity and mortality among young adults (The National Heart Foundation of New Zealand, 2007). In conjunction to this statistic, this essay will examine the pathophysiology and epidemiology of ARF and RHD in New Zealand. Furthermore the role of paramedics and contributions paramedics could make to reduce the burden of ARF and RHD on New Zealand society will be presented in discussion.

Group A streptococcal (GAS) pharyngitis infections have a strong correlation with ARF and RHD. Group A streptococcal (GAS) is a derivative of beta-hemolytic streptococci, based upon the difference in the cell wall polysaccharide build. GAS is again categorised, based on its M type, to which defines the virulence of the particular bacterium. The M protein has been resea...

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Steer, A. C., & Carapetis, J. R. (2009). Acute rheumatic fever and rheumatic heart disease in indigenous populations. The Pediatric Clinics of North America, 56(6), 1401-1419. doi:10.1016/j.pcl.2009.09.011

St John New Zealand. (2013). Clinical Practise Guidelines 2013-2015. Wellington, New Zealand: St John New Zealand.

The National Heart Foundation of New Zealand (Heart Foundation), (2007). A Summary of the New Zealand Guidelines for Rheumatic Fever. Retrieved February 27, 2014, from

Webb, R., & Wilson, N. (2013). Rheumatic fever in new zealand. Journal of Paediatrics and Child Health, 49(3), 179-184. doi:10.1111/j.1440-1754.2011.02218.x

Wilson, N. (2010). Rheumatic heart disease in indigenous populations--new zealand experience. Heart, Lung & Circulation, 19(5), 282-288. doi:10.1016/j.hlc.2010.02.021

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