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Clinical presentation

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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