Chronic rheumatic carditis

What is chronic rheumatic carditis?

Rheumatic carditis lasting more than 6 months is considered as chronic rheumatic carditis. Evidence of recent streptococcal infection as an essential criteria for the diagnosis of rheumatic carditis cannot be applied in this situation. Such cases may present with late onset heart failure in rheumatic fever. It is also known as smouldering carditis in rheumatic fever.

As per the World Health Organization Technical Report Series 923 on Rheumatic Fever and Rheumatic Heart Disease, published in 2004, diagnosis of this form of insidious onset rheumatic carditis does not require other major manifestations or evidence of preceding Group A streptococcal infection. Same exception also applies in case of Rheumatic chorea as both are late manifestations and evidence of Group A streptococcal infection would have disappeared by the time they manifest clinically.

Teaching personnel working in schools with children having recurrent streptococcal infection are prone to get recurrent streptococcal infection and consequently stand the chance of developing such chronic rheumatic activity without an acute phase and development of indolent carditis [2]. This is also sometimes called as primary rheumatic carditis as it manifests with carditis alone, without other manifestations.

Many cases which present with chronic rheumatic heart disease in adult life without any definite history of rheumatic fever earlier may belong to this category. It is also thought that earlier in childhood, rheumatic fever may manifest with carditis alone, without arthritis and thus be missed during the initial episode with rheumatic carditis and later present with chronic rheumatic valvular lesions.

References

1. World Health Organization Technical Report Series 923 on Rheumatic Fever and Rheumatic Heart Disease, 2004, page 21.
2. A Radivoievici, L Stanciu, I Riviş, I Branea, R Avram, I Corlan, M Miu. Diagnosis of primary chronic rheumatic carditis in adults. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol. 1979;24:173-80.