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THE IMPORTANCE OF SILENT CARDITIS IN PATIENTS WITH RHEUMATIC FEVER

Aytul Parlar, Erturk Levent, A. Ruhi Ozyurek, Ayvaz Aydogdu, Hasan Guven

Ege University, Medical Faculty, Department of Pediatric Cardiology, Izmir, TURKEY

Rheumatic fever is the most common cause of acquired heart disease in children and young adults. The physical findings and supporting laboratory evidence as defined by the Jones criteria are the bases of diagnosis of Rheumatic fever. Rheumatic carditis is characterized by auscultation of mitral regurgitant murmur. Mitral regurgitation can be detected by Doppler echocardiography when there is no murmur (silent mitral regurgitation) even in normal individuals in the case of no murmur. Mild valvular regurgitation with no murmur has been encountered in the patients with Rheumatic fever manifested by isolated polyarthritis and chorea. Between 1994-1999, in our department, 74 patients with rheumatic fever were diagnosed according to Jones’ criteria. All patients were evaluated by clinical and echocardiographic examination with respect to heart involvement. The 46 (62%) of these patients have carditis and the 6 (8%) of them have pure chorea. In the 4 (8%) of the 46 patients with carditis and in the 4 (66%) of the 6 patients with chorea, the heart murmur disappeared clinically, however in these patients silent carditis (mild mitral regurgitation) was detected with Doppler echocardiography. We found that mild valvular regurgitation which can not be clinically audible but echocardiographically significant was frequently seen in patients with pure chorea. These data support the use of Doppler echocardiography as a criterion for carditis and its importance in detecting silent valvular regurgitation and in deciding the duration of prophylaxis.