Rheumatic fever in children. A follow-up study with emphasis on cardiac sequelae

Eighty-nine children with rheumatic fever between 1964 and 1978 were reviewed. There were 40 males and 49 females. The first attack occurred mostly between 6 and 12 years. Arthritis was present in 62.9%; carditis, 55.1%; chorea, 19.1%. Children were followed from 20 months to 15 years (mean 61 months). Seventeen developed current attacks (19.1%). On final examination, 40 had no heart disease, 30 had mild heart disease, 6 required valve surgery, 4 had died, and 9 had moderate heart disease but not operated. Chorea was present in 20 children. Six of them also had mitral insufficiency, 3 had recurrence after episode of chorea. Prompt diagnosis and treatment of streptococcal infection and penicillin prophylaxis need to be stressed. Service carditis on initial attack and recurrence predispose to the development of severe heart disease.