The Subsidence of Heart Signs in Rheumatic Fever *

The present study was undertaken to determine the degree and frequency with which healing of the lesions of rheumatic heart disease occurs, as expressed by the disappearance of physical signs after the active stage of the infection. The problem presents immediate controversial aspects as to: (a) the diagnostic criteria for determining the presence of rheumatic heart disease; (b) its severity; and (c) the differentiation between active and inactive cardiac lesions of rheumatic fever. It is obvious that, with the available clinical methods of diagnosis, one cannot expect to detect all the minor pathological changes which may occur in the heart in rheumatic fever; the stethoscope and even the electrocardiograph are limited means of telling the whole story. Certainly subclinical degrees of rheumatic heart disease exist and it is evident that most of the lesions that become apparent to the clinician through the usual methods of physical diagnosis are generally manifestations of moderately severe involvement. Furthermore, since an able examination and an accurate interpretation of the findings entail a considerable degree of clinical judgment, a strong personal element is introduced into the problem. The clinical course of patients suffering rheumatic cardiac lesions is dependent in part upon the severity of the legion and in part upon the intensity and duration of the active stage of the infection. It has long been known that certain changes in the physical signs referable to the heart appear in patients with active rheumatic fever and that these signs disappear slowly or promptly with the subsidence of the infection. It is questionable whether or not these signs, which include tachycardia, certain cardiac murmurs and changes in the electrocardiographic tracings, are actual indications of orthodox heart disease. It is, in many ways, a question of nomenclature or definition, and it at once becomes apparent that the incidence of