Pediatric Cardiology

, Volume 29, Issue 6, pp 1048–1053

What is the True Frequency of Carditis in Acute Rheumatic Fever? A Prospective Clinical and Doppler Blind Study of 56 Children with up to 60 Months of Follow-Up Evaluation

  • Álvaro Manuel Caldas
  • Maria Teresa Ramos Ascensão Terreri
  • Valdir Ambrosio Moises
  • Célia Maria Camelo Silva
  • Cláudio Arnaldo Len
  • Antonio Carlos Carvalho
  • Maria Odete Esteves Hilário
Original Article


Background This study aimed to evaluate prospectively clinical and echocardiographic findings of patients who had rheumatic fever with and without clinical features of cardiac involvement. Methods For this study, 56 consecutive patients (mean age, 11.4 years) with acute rheumatic fever diagnosed according to the 1992 modified Jones criteria were evaluated at diagnosis, after 3 and 6 months, then at 2 and 5 years. All assessments were performed blindly and included physical and cardiac examination, electrocardiogram, chest X-ray, and two-dimensional color-flow Doppler echocardiography. Results Initial clinical carditis was observed for 27 patients (48.2%), all of whom had positive echocardiographic abnormalities. Echocardiographic abnormalities were observed in 11 patients who had arthritis or chorea presentation without initial clinical carditis. Persistence of the abnormalities was observed at a late follow-up evaluation in 72.7% of the cases. Sydenham’s chorea was present in 8 patients with clinical carditis and in 10 without this disorder, 8 of whom had echocardiographic abnormalities. Conclusion Patients who had acute rheumatic fever without clinical signs of carditis showed acute and late follow-up echocardiographic abnormalities suggestive of cardiac involvement. Clinicians should be attentive for the presence of cardiac involvement among patients with chorea.


Echocardiography Jones criteria Rheumatic fever Subclinical carditis Sydenham’ chorea 


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Álvaro Manuel Caldas
    • 1
  • Maria Teresa Ramos Ascensão Terreri
    • 1
    • 2
  • Valdir Ambrosio Moises
    • 3
  • Célia Maria Camelo Silva
    • 3
  • Cláudio Arnaldo Len
    • 1
  • Antonio Carlos Carvalho
    • 3
  • Maria Odete Esteves Hilário
    • 1
  1. 1.Division of Allergy, Clinical Immunology and RheumatologyUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
  2. 2.São PauloBrazil
  3. 3.Discipline of Cardiology, Department of MedicineUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil

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