Required to make the diagnosis
Two major criteria or one major and two miner criteria plus supportive evidence of preceding group A streptococcal infection (markedly raised ASOT titre or group A streptococcus on throat culture)
a) Pan carditis- 50%, early manifestation
Myocarditis -may lead to heart failure & death
Pericarditis- pericardial friction rubs, pericardial effusion, tamponade
b) Poly arthritis-80%, early manifestation, ankle, knee& wrist, moderate redness
and swelling, migrating to other joint
c) Sydenham’s chorea- 10%, late manifestation, 2 to 6 month after infection,
involuntary movements, usually ESR/ASOT return to
normal at that time.
d) Erethema marginatum -<5% , uncommon, early manifestation,
e) Subcutaneous nodules-late manifestation, pain less, mainly on the extensor
b) Poly athralgia
c) History of rheumatic fever
d) Raised acute reactants- ESR, CRP
e) Prolonged P-R interval on ECG
In the 3 special categories listed below the diagnosis of rheumatic fever is acceptable without 2 major or 1 major & 2 miner criteria. However for 1 & 2 can the requirement for evidence of a preceding streptococcal infection can be ignored.
1. Chorea if other causes excluded
2. Insidious or late onset carditis with no other explanation.
3. Rheumatic recurrence- In patient with documented rheumatic disease or prior rheumatic fever, the presence of one major criterion or of fever, arthralgia diagnosis of recurrence.
This patient is not presented in acute stage. There fore we can’t diagnosis with criteria. As mention above using exceptions of Duckett Jones criteria we can diagnose.
In echo mitral valve regurgitation and vegetation can be identified. It also shows features of cardiac failure- dilated left ventricle. Congenital mitral regurgitation very rare & it should identify early. Child also didn’t get any symptoms of heart failure. So it should be acquired condition. Matral valve is the most common valve that can affect in rheumatic heart disease.