Complications

Complications include:

Carditis which involves the three layers of the heart:

• bread and butter pericarditis, which may cause a friction rub, invariably resolving with few sequelae
• myocarditis - may cause heart failure. Dilatation may result in valvular incompetence, most commonly mitral.
• endocarditis and valvulitis - chronic rheumatic heart disease ensues in 50% of those with RF and carditis. Valvular damage is common, especially stenosis.

The frequency of involvement is given below:

Valve(s) % rheumatic valve lesions

• mitral 50
• mitral and aortic 40
• mitral, aortic and tricuspid 5
• aortic 2
• other combinations 3

Although chronic rheumatic heart disease is compatible with a normal life span there is a considerable risk of decompensation and heart failure in older age.

• central nervous system complications may result in Sydenham's chorea