Doppler echocardiography and the early diagnosis of carditis in acute rheumatic fever

Abstract

Doppler echocardiography is more sensitive than clinical assessment in the detection of carditis in acute rheumatic fever, and can contribute to earlier diagnosis.

Acute rheumatic fever without early carditis: an atypical clinical presentation

“…Silent carditis was reported with an incidence which varied between 7% and 47%, depending on the phase which the disease has reached when the echocardiography is performed [2,29]. With suboptimal auscultation skills [17,26], an echo-Doppler investigation will quickly confirm the presence or absence of valvular involvement when a clinically detectable murmur is present [2,7,12].Two of our patients (2 and 3) had silent carditis and the diagnosis was established only after echocardiography. These findings highlight the importance of repeating echocardiography over the next 3-4 weeks, as valvular involvement, which was absent initially, may appear later, supporting the view, that echocardiographic findings should be considered as a major criterion for the diagnosis of ARF [30].…”

Proceedings of the Jones Criteria Workshop

“…Doppler criteria to distinguish physiological from pathological mitral regurgitation have been proposed by investigators who care for large numbers of patients with acute rheumatic fever. [23][24][25][26] At present, however, these criteria have not been universally accepted.…”

Doppler echocardiographic assessment of subclinical valvitis in the diagnosis of acute rheumatic fever

“…Stricter Doppler echocardiographic criterions have now been established, therefore, to permit a more confident differentiation between the characteristics of physiological and pathological valvar regurgitation. 4,[13][14][15][16] It remains a fact, however, that the lack of an accurate diagnosis of cardiac lesions can contribute to the underdiagnosis and, consequently, interfere in the management of patients. The use of anti-inflammatory medication is required for carditis, but is not required for pure chorea.…”