HEART DISEASE

Tuesday, November 1, 2011

The heart is affected in most cases of rheumatic fever and this occurs too commonly to be referred to merely as a complication. There are about 25,000 deaths from about 20 per cent of all cardiac deaths. Rheumatic fever is in fact the most common cause of heart disease under the age of 50. In the early stages this may be suspected from diminished intensity of the first heart sound or from the development of a blowing systolic murmur. A transient diastolic murmur may be heard. There may of course, be evidence of previous rheumatic infection, e.g. mitral stenosis or aortic incompetence. Pericarditis may be suspected as a complication when there is a recrudescence of fever with the development of malaise, restlessness and pallor. Retrosternal or praecordial pain is common and pericardial friction may be heard. Characteristic changes may occur in the electrocardiogram an effusion may develop. Pericarditis itself is not a serious manifestation of rheumatic fever, but its association with myocarditis is almost invariable.