ABSTRACT
Sydenham's chorea [SC] is a late manifestation of rheumatic fever [RF] and its presence alone warrants the diagnosis of RF. Although SC seems to be a benign condition, 27% of patients who present with "pure chorea" to develop most likely rheumatic valvular disease within thirty years of the initial attack. To study the cardiac involvement in chorea patients without clinical signs of carditis the following investigation was carried out: Seventeen patients with chorea aged 7-15 years [mean +/- SD: 11.3 +/- 1.9] and 17 neurologic patients together with 28 normal children were surveyed with color flow imaging [CFI]. All chorea patients had left sided valvular regurgitation, whereas only one in each control group had the same finding, [p< 0.001]. We conclude that many, if not all, of the Sydenham's chorea patients have subclinical carditis. Doppler study is a valuable tool for detection of cardiac involvement. This underlines the rationale for patients with SC and "normal" heart to be placed on chemoprophylaxis, despite the absence of auscultatory findings on physical examination. To further evaluate these findings a larger group of children should be studied