acute rheumatic carditis

Acute rheumatic carditis is the heart inflammation that occurs during an episode of rheumatic fever. It is the most consequential part of the illness because, unlike the arthritis and rash which heal completely, damage to the heart can be permanent. It is the only manifestation of rheumatic fever that leaves lasting harm.

The inflammation can involve all three layers of the heart, which is why it is sometimes called a pancarditis. Most important is endocarditis affecting the valves, especially the mitral and aortic valves, where inflammation leads first to leakage (regurgitation) and later, after scarring, to narrowing (stenosis). The muscle (myocarditis) and the sac (pericarditis) may also be inflamed, occasionally with a friction rub or effusion.

Clinically, doctors look for a new murmur, an enlarged heart, signs of heart failure, or a pericardial rub. Treatment targets the underlying rheumatic fever with anti-inflammatory drugs and antibiotics to clear any lingering streptococcus, plus heart-failure therapy if needed. The valve injury sustained during repeated or severe episodes is what later evolves into chronic rheumatic heart disease.