Rheumatic fever physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S.

Physical Examination

General appearance

High index of suspicion is required in diagnosing rheumatic fever. Patients presents frequently with joint involvement and fatigue.

Vital signs

• Fever
• Normotension or Hypotension (if heart or pericardium is involved)
• Tachycardia
• Tachypnea (if heart valves, pericardium or myocardium are involved leading to cardiac dysfunction)

Cardiac examination

Cardiac involvement is the second most common complication of rheumatic fever.

• Tachycardia
• Jugular venous distension may be noted if the patient has congestive heart failure secondary to valvular involvement or myocarditis.
• Precordial heave may be noted in chronic rheumatic disease with mitral valve involvement.
• Cardiac murmurs may be noted if heart valves are involved. Regurgitant murmurs are common in acute rheumatic fever, while chronic rheumatic fever is associated with murmurs of valve stenosis.
  • Mitral insufficiency (holosystolic murmur) is the most common valvular abnormality reported in rheumatic fever and may be accompanied by aortic insufficiency (early diastolic murmur).
  • Aortic stenosis (systolic ejection murmur) or mitral stenosis (mid diastolic murmur) may be noted in chronic rheumatic fever secondary to scarring and calcification of damaged valves.