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
• 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).