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November 26, 1982

Immunologic Aspects of Cardiovascular Disease

JAMA. 1982;248(20):2716-2721. doi:10.1001/jama.1982.03330200140026


Clinical Findings  RHEUMATIC fever is an acute febrile illness characterized by inflammation of the heart, joints, and subcutaneous tissues. Characteristic diagnostic features have been grouped into so-called major and minor criteria. Among the major clinical manifestations of the disease are polyarthritis, carditis, subcutaneous nodules, erythema marginatum, and chorea. Minor manifestations include fever, arthralgia, a history of previous rheumatic fever or rheumatic heart disease and the presence of certain laboratory findings. Among these laboratory findings are an elevated erythrocyte sedimentation rate, prolongation of the PR interval on the ECG, leukocytosis, and the presence of acute phase reactants in the blood (such as C reactive protein). The criteria require, in addition, evidence of a preceding streptococcal infection detected by antibody studies, results of throat culture, or history of scarlet fever.Features of cardiac involvement consist of heart murmurs, cardiomegaly, congestive heart failure, pericardial friction rubs, or signs of effusion.