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Echocardiography in acute rheumatic fever
The Annals of Pediatric Cardiology, 06/24/09

Ramakrishnan S – Review emphasizes the utility of echocardiography in the diagnosis of subclinical carditis. Since the long-term outcome of patients with subclinical carditis is less well established, it is suggested that all pts with suspected or definite RF should undergo echocardiography to identify and assess the severity of carditis. Some of the points discussed are detailed here:

Echocardiographic features of rheumatic carditis are:
- Vulvular regurgitation
- Leaflet: Prolapse, Coaptation failure, Thickening, Reduced mobility and Nodules
- Annular dilation
- Chordal elongation/rupture
- Increased echogenecity of subvalvular apparatus
- Pericardial effusion
- Ventricular dilation and dysfunction
Subclinical carditis:
The reported prevalence of subclinical carditis in RF ranges from 0 to 5. However, the outcome of these pts is less well established.
Inclusion of echocardiography as a 'Jones Criterion' - The Cons:
For echocardiography to be included as a diagnostic criterion, 3 things need to be established:
1. Incidence of subclinical carditis should be significant.
2. Outcome of subclinical carditis should not be benign.
3. Treatment or prophylaxis should alter the outcome.
Inclusion of echocardiography as a 'Jones Criterion' - The Pros
Major confusion for the clinician in ordering an echocardiography is in pts with polyarthritis and chorea with no clinical evidence of carditis.