Clinical presentation

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