Rheumatic fever

Most patients respond well to treatment and can be discharged from hospital within 2 weeks. Patients with progressive or severe carditis often require a longer admission with careful monitoring of clinical condition based on clinical examination, serial echocardiography, ECG, and chest x-ray.

The erythrocyte sedimentation rate and C-reactive protein should be measured weekly initially, and then every 1 to 2 weeks until they normalise, when possible. Echocardiography should be repeated after 2-4 weeks if the initial diagnosis is unclear or if the initial episode was severe.

All patients who have had carditis should be reviewed by their primary medical practitioner at 6-monthly intervals and by a specialist cardiologist with echocardiography every 1 to 2 years. If moderate to severe rheumatic valve disease is present, more frequent review is advised. The importance of prophylaxis can be emphasised at follow-up. Patients with valvular involvement will need a full dental assessment, prior to elective valve surgery.