This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Narula, J. Articles by Rahimtoola, S. Search for Related Content PubMed PubMed Citation Articles by Narula, J. Articles by Rahimtoola, S. Related Collections Valvular heart disease Echocardiography

(Circulation. 1999;100:1576-1581.)
© 1999 American Heart Association, Inc.

Current Perspective

Diagnosis of Active Rheumatic Carditis

The Echoes of Change

Jagat Narula, MD, PhD; Y. Chandrasekhar, MD; Shahbudin Rahimtoola, MB, FRCP

From the Division of Cardiovascular Diseases (J.N.), Hahnemann University School of Medicine, Philadelphia, Pa; University of Minnesota School of Medicine (Y.C.), Minneapolis, Minn; and University of Southern California (S.R.), Los Angeles, Calif.

Correspondence to Jagat Narula, MD, PhD, Heart Failure/Transplant Center, Hahnemann University Hospital, Broad & Vine, Mail Stop 115, Philadelphia, PA 19102. E-mail Narula@auhs.edu

Key Words: rheumatic heart disease • endocarditis • mitral regurgitation • arthritis • streptococcal infections

 
Not everything that counts can be counted, and not everything that can be counted counts. Albert Einstein

Acute rheumatic fever (RF) continues to be a major health problem at the dawn of the new millennium in many parts of the world.^{1 2 3} Rheumatic heart disease (RHD), the sequel of RF, is a very common cause of cardiovascular mortality and morbidity,^{1 2 3 4 5} accounts for 35% to 40% of cardiovascular disease-related hospital admissions, and is the predominant indication for cardiac surgery in developing countries.^{1 6} Although traditionally considered to be a disease associated with poverty and overcrowding, RF continues to persist, even among the prosperous middle-class population in developed countries.^{7 8 9}

Although RF is a systemic disease with multiorgan involvement, none of its manifestations, except for carditis, lead to permanent damage. Clinical cardiac involvement has been reported in nearly one-third to almost all patients with RF in various series and in up to 50% of patients in prospective studies.¹⁰ Detection of active rheumatic carditis is of great prognostic and therapeutic importance and is currently based on the Jones criteria. Not infrequently, the diagnosis of carditis by the Jones criteria becomes difficult, especially when carditis is the isolated manifestation of the disease or when the rheumatic activity occurs on preexisting RHD.^{11 12 13} It is important to develop a diagnostic strategy that will improve our ability to diagnose rheumatic carditis and allow us to apply existing criteria more efficiently.^{13 14} The advent of modern, highly sensitive cardiac imaging modalities, predominantly echocardiography/Doppler ultrasound (echo-Doppler), has raised the question whether the . . . [Full Text of this Article]

This article has been cited by other articles:

				F. Antonini-Canterin, E. Leiballi, R. Enache, B. A. Popescu, M. Rosca, E. Cervesato, R. Piazza, C. Ginghina, and G. L. Nicolosi Hydroxymethylglutaryl Coenzyme-A Reductase Inhibitors Delay the Progression of Rheumatic Aortic Valve Stenosis: A Long-Term Echocardiographic Study J. Am. Coll. Cardiol., May 19, 2009; 53(20): 1874 - 1879. [Abstract] [Full Text] [PDF]

				I. Korn-Lubetzki, A. Brand, and I. Steiner Recurrence of Sydenham Chorea: Implications for Pathogenesis Arch Neurol, August 1, 2004; 61(8): 1261 - 1264. [Abstract] [Full Text] [PDF]

				L. Y. Tani, L. G. Veasy, L. L. Minich, and R. E. Shaddy Rheumatic Fever in Children Younger Than 5 Years: Is the Presentation Different? Pediatrics, November 1, 2003; 112(5): 1065 - 1068. [Abstract] [Full Text] [PDF]

				J. Kamblock, L. Payot, B. Iung, P. Costes, T. Gillet, C. Le Goanvic, P. Lionet, B. Pagis, J. Pasche, C. Roy, et al. Does rheumatic myocarditis really exists? Systematic study with echocardiography and cardiac troponin I blood levels Eur. Heart J., May 1, 2003; 24(9): 855 - 862. [Abstract] [Full Text] [PDF]

				P. Ferrieri and for the Jones Criteria Working Group Proceedings of the Jones Criteria Workshop Circulation, November 5, 2002; 106(19): 2521 - 2523. [Full Text] [PDF]

				F E Figueroa, M S. Fernández, P Valdés, C Wilson, F Lanas, F Carrión, X Berríos, and F Valdés Prospective comparison of clinical and echocardiographic diagnosis of rheumatic carditis: long term follow up of patients with subclinical disease Heart, April 1, 2001; 85(4): 407 - 410. [Abstract] [Full Text]