title: [Silent enemy in acute rheumatic fever: subclinical carditis].
abstract: OBJECTIVE
  Routine use of Doppler echocardiography for the initial diagnosis of acute rheumatic fever (ARF) might allow early detection and, hence, prevention of rheumatic recurrences. This study sought to determine the incidence of subclinical carditis in ARF patients.
  
  
  METHODS
  The study included 80 patients (64 migratory polyarthritis, 16 rheumatic chorea) who were diagnosed with ARF according to the Jones criteria, 1992 update. Rheumatic carditis was defined as the presence of the following findings on Doppler echocardiography: mitral and aortic regurgitant jets in at least two planes, the length of the jets >1 cm, and peak flow velocities of >2.5 m/sec for both mitral and aortic regurgitations persisting throughout systole and diastole, respectively. The patients diagnosed with subclinical carditis were re-evaluated at 1, 3, 6, and 12 months.
  
  
  RESULTS
  Echocardiography revealed subclinical carditis in 25 patients (31.3%; 13 girls, 12 boys; mean age 11.4±2.5 years) with ARF. Of 64 patients with migratory polyarthritis, 34 (53.1%) had clinical carditis and 17 (26.6%) had subclinical carditis. The incidences of clinical and subclinical carditis among 16 patients with rheumatic chorea were 31.3% (n=5) and 50% (n=8), respectively. Of 20 patients who completed one-year follow-up, persistence of subclinical carditis was observed in 11 cases (55%).
  
  
  CONCLUSIONS
  Clinicians should be attentive to the presence of cardiac involvement among patients with suspected ARF. Considering the high incidence of subclinical carditis, echocardiographic evidence of carditis should be used as a diagnostic criterion.
authors.affiliation: Department of Pediatrics, Keçiören Education and Research Hospital, Ankara, Turkey. pedkard@gmail.com
authors.forename: Osman
authors.initials: O
authors.lastname: Ozdemir
authors.forename: Sehribanu
authors.initials: S
authors.lastname: Işık
authors.forename: Ayhan
authors.initials: A
authors.lastname: Abacı
authors.forename: Samil
authors.initials: S
authors.lastname: Hızlı
authors.forename: Ahmet Zülfikar
authors.initials: AZ
authors.lastname: Akelma
authors.forename: Fatih Mehmet
authors.initials: FM
authors.lastname: Kışlal
authors.forename: Aydın
authors.initials: A
authors.lastname: Celik
authors.forename: Cem Hasan
authors.initials: CH
authors.lastname: Razi
authors.forename: Mesut
authors.initials: M
authors.lastname: Koçak
mesh_terms: D002648:Child; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012213:Rheumatic Fever / Q000150:complications* / Q000000981:diagnostic imaging; D012214:Rheumatic Heart Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging