Lab workup of Rheumatic Fever

C-reactive protein and erythrocyte sedimentation rate are elevated in individuals with rheumatic fever
due to the inflammatory nature of the disease. Both tests have high sensitivity but low specificity for
rheumatic fever.

Chest radiography

Cardiomegaly, pulmonary congestion, and other findings consistent with heart failure may be observed
on chest radiograph in individuals with rheumatic fever (as is shown on the image below).

Other Tests

ECG findings include the following:

Sinus tachycardia most frequently accompanies acute RHD. Alternatively, some children develop sinus
bradycardia from increased vagal tone. No correlation between bradycardia and severity of carditis is
observed.

First-degree atrioventricular (AV) block (prolongation of PR interval) is observed in some patients with
RHD. This abnormality may be related to localized myocardial inflammation involving the AV node or to
vasculitis involving the AV nodal artery. First-degree AV block is a nonspecific finding and should not be
used as a criterion for the diagnosis of RHD. Its presence does not correlate with the development of
chronic RHD.

Second-degree (ie, intermittent) and third-degree (ie, complete) AV block with progression to
ventricular standstill have been described. However, heart block in the setting of rheumatic fever
typically resolves with the rest of the disease process.

In individuals with acute pericarditis, ST segment elevation may be present, most marked in leads II, III,
aVF, and V4 through V6.

Finally, patients with RHD may develop atrial flutter, multifocal atrial tachycardia, or atrial fibrillation
from chronic mitral valve disease and atrial dilation.

In individuals with acute RHD, echocardiography identified and quantitated valve insufficiency and
ventricular dysfunction. Studies in Cambodia and Mozambique demonstrated a 10-fold increase in the
prevalence of RHD when echocardiography is used for clinical screening compared with strictly clinical
findings. [16]
ECG

Mitral valve regurgitation is a type of heart valve disease in which the valve between the left heart
chambers doesn't close completely, allowing blood to leak backward across the valve.

Acute phase reactants inflammation markers that exhibit significant changes in serum concentration
during inflammation. the erythrocyte sedimentation rate (ESR), and C-reactive protein levels (CRP) are
usually elevated at the onset of ARF and serve as a minor manifestation in the Jones criteria.

ASO is an antigen test