Involvement of the heart can be recognized in approximately 70 per cent of patients during the course of rheumatic fever in childhood1 (table 1). It is generally believed that the remaining 30 per cent also have at the same time minimal cardiac damage too slight to be evident by present methods of clinical study. The later appearance during subsequent years of characteristic signs of permanent valvular deformity in a considerable number of the latter group lends support to this conception. This delayed appearance of heart disease is responsible, however, for one of the chief elements of uncertainty with which these patients with so-called potential rheumatic heart disease must contemplate the future. This uncertainty is due in part, we believe, to a lack of information concerning the actual incidence and the extent of this later, and often insidious, crippling of the heart.
Continuity of observation based on the entire life span of a large number of patients with potential rheumatic heart disease in different sections of the country will be necessary for conclusive data. It is evident, however, that studies of such duration lie in large measure outside the scope of contemporary medical experience
BLAND EF, JONES TD. THE DELAYED APPEARANCE OF HEART DISEASE AFTER RHEUMATIC FEVER. JAMA. 1939;113(15):1380–1383. doi:10.1001/jama.1939.02800400008003
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