ECHOCARDIOGRAPHIC DIAGNOSIS OF SUBCLINCAL CARDITIS IN ACUTE RHEUMATIC-FEVER

The diagnosis of carditis in acute rheumatic fever traditionally depen ds on characteristic auscultatory findings. The advent of pulsed and c olour Doppler echocardiography provides a method of detecting minor de grees of pathological regurgitation without characteristic clinical si gns. Using strict criteria, pathological left heart regurgitation can be differentiated from physiological regurgitation: colour Doppler mus t show a substantial colour jet in two planes extending well beyond th e valve leaflets; pulsed Doppler must confirm a high velocity signal, holosystolic for mitral regurgitation, or holodiastolic for aortic reg urgitation. Several centres have observed subclinical carditis in chil dren with acute rheumatic fever. We are confident that we are not over diagnosing valvulitis, having tested this in a blinded fashion. Subcli nical valvulitis should be accepted as evidence of carditis, a major d iagnostic criterion for acute rheumatic fever.