DISAPPEARANCE OF THE PHYSICAL SIGNS OF RHEUMATIC HEART DISEASE

Abstract

We are presenting in this report observations on the disappearance of certain physical signs considered characteristic of rheumatic involvement of the heart. The appearance of so-called organic murmurs during the course of rheumatic fever or chorea is generally accepted as evidence of valve injury. Cardiac enlargement when present lends further support to the clinical impression of extensive involvement of the heart. It has been shown recently that dilatation alone may be an important factor during severe rheumatic infection responsible in some instances for cardiac murmurs; especially for a mid-diastolic rumbling sound at the cardiac apex previously considered indicative of mitral stenosis.¹It is evident, however, from both clinical observation and postmortem study that with demonstrable involvement of the heart during rheumatic fever the mitral valve rarely escapes and, furthermore, the aortic cusps are injured in over half the cases. The persistence of characteristic murmurs after subsidence of the infection