Some notes on the history of rheumatic carditis

RESUMO

The history of rheumatic heart disease is briefly surveyed. Mitral regurgitation was recognized as the dominant lesion in acute carditis in the 1830s. This diagnosis fell out of favour in the early twentieth century. Also valvular lesions were then considered to be less important than myocardial disease as a cause of symptoms in chronic rheumatic heart disease. Successful mitral valvotomies in 1948 corrected this view. Mitral stenosis takes years to develop after acute valvulitis. Studies from the rheumatic fever research unit at Taplow showed absence of cardiac dilatation in first attacks of rheumatic carditis, poor prognosis with pericardial effusions, changing murmurs recorded by phonocardiography and cardiac output studies that justified treatment by bed rest. The multicentre trial of cortisone, adrenocorticotrophic hormone (ACTH) and salicylates showed no differences in development of chronic valvular disease. There is need for a more specific test for rheumatic activity than the erythrocyte sedimentation rate (ESR). It is hoped that a test can be developed to identify the minority of children at risk from rheumatic fever after a streptococcal throat infection in order to target antibiotic use. The declining prevalence of rheumatic fever is confined to the more prosperous countries. It remains common in the developing world. Penicillin prophylaxis is the sole advance in therapy. Better socio-economic environments are needed to reduce prevalence.