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By J. and R. Subik Riha

ISBN-10: 0706414926

ISBN-13: 9780706414929

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Extra resources for Illustrated Encyclopedia of Cacti and Other Succulents

Example text

It is a transient, non-pruritic skin rash, pink or faintly red, usually affecting the trunk, sometimes the proximal parts of the limbs, but never the face. It consists of a variable number of erythematous patches of 1-3 cm diameter which may be slightly raised. Each lesion extends centrifugally while the skin in the centre clears, so that the margins are pink, while the centre is pale; hence the name "erythema marginatum". The margin ofthe lesion is usually continuous, making a ring; hence the other name, "erythema annul are " .

Other disturbances of conduction may include second-degree A-V block, A-V dissociation (which may occur in as many as 20% of cases), and even complete A-V block. Premature ventricular beats, bigeminy and acute atrial fibrillation may also occur. Silent carditis Up to 50% of patients with the physical findings of rheumatic heart disease deny any history of rheumatic fever attacks. It is assumed that these patients had an attack of rheumatic fever involving the heart, but without pericarditis or congestive failure, and with neither polyarthritis nor chorea (and therefore asymptomatic).

Arthritis is an early, transient and self-limited manifestation and in areas where children are often seen late in the course of an attack, the joint symptoms will have subsided. The distinction between polyarthralgia and polyarthritis can rarely be made with certainty from the history alone, since it is sometimes difficult to make this distinction even on physical examination. Also, the incidence of joint manifestations may be underestimated because patients with arthritis and no carditis are less likely to be admitted to hospitals when beds are at a premium.

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Illustrated Encyclopedia of Cacti and Other Succulents by J. and R. Subik Riha


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