clinical presentation
Last reviewed 06/2022
Clinical features are as follows:
- patients are 5 to 15 years old
- streptococcal infection is a prerequisite for subsequent development of rheumatic fever
- the latent period following a streptococcal infection is 2 to 6 weeks
- typically the patient will have migratory polyarthritis with a low-grade fever
- 50-75% of children will develop acute carditis; in adults this figure is only 35%
- myocarditis causes arrythmias, usually atrial fibrillation, and a prolonged P-R interval
- cardiac dilatation may occur, resulting in murmurs of valvular insufficiency, mitral most commonly, then aortic, then tricuspid
- valvulitis is marked by the systolic murmur of mitral regurgitation and the diastolic murmur of aortic regurgitation
- subcutaneous nodules are a rare feature
Other abnormal findings on cardiovascular examination include:
- sinus tachycardia
- raised jugular venous pressure, due to heart failure which is now rare
- a Carey-Coombs murmur