The appearance of new cardiac murmurs in patients having rheumatic heart disease with no concomitant evidence of rheumatic activity

Abstract

In four children who had had rheumatic fever a new cardiac murmur was observed in the course of routine examination at a time when the disease had been regarded as in a quiescent stage. This was taken as evidence of activity of the rheumatic process. The values of three acute phase reactants (the erythrocyte sedimentation rate, C-reactive protein and serum mucoprotein) and of antibodies to two hemolytic streptococcal antigens (antistreptolysin and antihyaluronidase) were found to be within normal limits in these patients at the time the evidence of extension of the rheumatic process was observed, and to have shown only minor variations during the preceding months. The values of these three acute phase reactants were also within normal limits in two other patients in whom the activity of the rheumatic process was doubtful or at a barely detectable level. The results of serial determinations of these values are presented in some of these patients, as well as in a group with long continued overt activity of rheumatic fever, and of other patients in whom a single episode of this disease was followed by a prolonged quiescent period. The significance of these findings in relation to variants in the natural history of rheumatic fever is discussed.