Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients Caregivers Providers
Log In Ask a Question
PubMed This is a summary of 14 peer-reviewed journal articles Updated
Pediatrics · Acute Rheumatic Fever

Protecting the Heart: Echocardiograms and RHD

At a Glance

An echocardiogram is a painless heart ultrasound that is critical for any child suspected of having rheumatic fever. It can detect silent heart inflammation before it causes permanent damage, ensuring your child receives the preventive treatments needed to protect their long-term heart health.

When a child is suspected of having Acute Rheumatic Fever (ARF), the single most important tool for protecting their long-term health is the echocardiogram (often called an “echo”). This is a completely painless ultrasound of the heart that allows doctors to see exactly how the heart valves are functioning in real-time [1].

The Invisible Threat: Subclinical Carditis

In the past, doctors only diagnosed heart involvement (carditis) if they could hear a heart murmur with a stethoscope. However, modern research has shown that many children have heart inflammation that is “silent” to the human ear [2].

This is known as subclinical carditis [3]. It means that while the heart sounds totally normal during a physical exam, the echocardiogram shows that the heart valves are inflamed or leaking [1]. Because even mild, unheard inflammation can lead to permanent damage, an echo is now considered a mandatory part of every ARF evaluation [4][1].

From Inflammation (ARF) to Permanent Damage (RHD)

It is very helpful to think of the difference between ARF and Rheumatic Heart Disease (RHD) as the difference between a new injury and a permanent scar:

  • Acute Rheumatic Fever (ARF): This is the active, inflammatory stage. The immune system is currently attacking the heart tissues [5]. With proper treatment and the prevention of future strep infections, this inflammation can sometimes resolve without leaving lasting damage [6].
  • Rheumatic Heart Disease (RHD): This is the chronic, permanent stage. It occurs when the initial inflammation—or repeated bouts of inflammation from new strep infections over the years—causes the heart valves to become scarred, thickened, or deformed [7][8].

Decoding the Echo Report

When you receive a copy of your child’s echo report, you may see several intimidating technical terms. These terms describe how the heart’s “doors” (the valves) are working:

Term What it Means in Plain Language
Regurgitation The valve is “leaky.” Instead of closing tightly, it lets blood flow backward in the wrong direction [9].
Insufficiency This is simply another medical word for a leaky valve (regurgitation) [10].
Stenosis The valve has become stiff or narrowed, making it hard for the heart to squeeze blood through the opening [11].
Pathological This means the leak is significant and caused by disease (like ARF), rather than a tiny, “physiological” leak that can be perfectly normal in healthy hearts [12][13].
Morphological Changes This refers to physical changes in the valve’s shape, such as thickening, fusion (leaflets sticking together), or restricted movement [10][11].

Why Early Detection Matters

Finding heart involvement early through an echo is vital because it changes how your child will be cared for going forward [6]. If any carditis is found, doctors will heavily prioritize secondary prophylaxis—a regimen of regular penicillin injections—to prevent any future strep infections from triggering another round of inflammation [6][14]. Maintaining this medical “shield” is the absolute most effective way to stop an episode of ARF from turning into a lifetime of Rheumatic Heart Disease [6].

Common questions in this guide

What is subclinical carditis?
Subclinical carditis is heart valve inflammation that cannot be heard with a stethoscope as a traditional heart murmur. It can only be detected using an ultrasound of the heart, known as an echocardiogram.
What is the difference between ARF and RHD?
Acute Rheumatic Fever (ARF) is the active, inflammatory stage where the immune system attacks heart tissues. Rheumatic Heart Disease (RHD) refers to the permanent scarring and damage to the heart valves that can remain after the inflammation stops.
What does valvular regurgitation mean on an echo report?
Valvular regurgitation means that a heart valve is leaky. Instead of closing tightly, the valve allows blood to flow backward in the wrong direction, which makes the heart work harder.
How does finding heart inflammation change my child's treatment?
If an echocardiogram shows any heart inflammation, doctors will prioritize secondary prophylaxis. This usually involves regular penicillin injections to prevent future strep infections from triggering more inflammation and causing permanent heart damage.
Why does my child need an echocardiogram if their heart sounds normal?
Many children experience silent heart inflammation that doesn't produce a detectable heart murmur during a physical exam. An echocardiogram is necessary because even mild, unheard inflammation can lead to permanent heart damage if left unmonitored.

Questions for Your Doctor

5 questions

  • •Did the echocardiogram find 'subclinical' or 'clinical' carditis?
  • •Can you show me on the report where it mentions 'valvular regurgitation' and explain if it is considered 'pathological'?
  • •Are there any structural changes to the valves, such as thickening or restricted movement?
  • •If there is inflammation right now, what are the chances this will lead to permanent Rheumatic Heart Disease (RHD)?
  • •How often will my child need follow-up echocardiograms to monitor the health of their heart valves?

Questions for You

3 questions

  • •Did the doctor mention hearing a heart murmur during the physical exam with a stethoscope, or was the heart issue found only on the ultrasound?
  • •Has your child been complaining of shortness of breath, chest pain, or feeling more tired than usual?
  • •How many weeks have passed since the initial strep infection and the heart ultrasound?

References

References (14)
  1. 1

    Acute rheumatic fever: 10-year single-center experience: clinical and laboratory findings, with subclinical carditis and treatment complications.

    Bulbul L, Akyol MB, Civan HA, et al.

    Cardiology in the young 2021; (31(9)):1489-1494 doi:10.1017/S1047951121003528.

    PMID: 34462031
  2. 2

    The 2015 revision of the Jones criteria for the diagnosis of acute rheumatic fever: implications for practice in low-income and middle-income countries.

    Beaton A, Carapetis J

    Heart Asia 2015; (7(2)):7-11 doi:10.1136/heartasia-2015-010648.

    PMID: 27326214
  3. 3

    Acute Rheumatic Fever in a COVID-19-Positive Pediatric Patient.

    DeVette CI, Ali CS, Hahn DW, DeLeon SD

    Case reports in pediatrics 2021; (2021()):6655330 doi:10.1155/2021/6655330.

    PMID: 33936829
  4. 4

    Clinical characteristics of pediatric patients with first-attack acute rheumatic fever following the updated guideline.

    Güler M, Laloğlu F, Olgun H, Ceviz N

    Turk pediatri arsivi 2019; (54(4)):220-224 doi:10.14744/TurkPediatriArs.2019.69376.

    PMID: 31949413
  5. 5

    Anti-streptococcal antibody and T-cell interactions with vascular endothelial cells initiate the development of rheumatic carditis.

    Sikder S, Rush CM, Govan BL, et al.

    Journal of leukocyte biology 2020; (107(2)):263-271 doi:10.1002/JLB.4MA0919-096RR.

    PMID: 31617241
  6. 6

    Changing face of acute rheumatic fever in childhood and our clinical results.

    Yavrum BE, Gul AEK, Azak E, et al.

    Northern clinics of Istanbul 2023; (10(2)):237-247 doi:10.14744/nci.2021.58966.

    PMID: 37181068
  7. 7

    How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018).

    Ghamrawy A, Ibrahim NN, Abd El-Wahab EW

    PLoS neglected tropical diseases 2020; (14(8)):e0008558 doi:10.1371/journal.pntd.0008558.

    PMID: 32804953
  8. 8

    The roles of immuno-modulator treatment and echocardiographic screening in rheumatic fever and rheumatic heart disease control: research from Aotearoa, New Zealand.

    Wilson N, Anderson A, Baker MG, et al.

    Journal of the Royal Society of New Zealand 2025; (55(2)):241-266 doi:10.1080/03036758.2024.2306981.

    PMID: 39677380
  9. 9

    Subclinical rheumatic heart disease: A single center experience.

    Kayali S, Belder N

    Northern clinics of Istanbul 2018; (5(4)):329-333 doi:10.14744/nci.2017.73384.

    PMID: 30859164
  10. 10

    The variable spectrum of anterior mitral valve leaflet restriction in rheumatic heart disease screening.

    Hunter LD, Doubell AF, Pecoraro AJK, et al.

    Echocardiography (Mount Kisco, N.Y.) 2021; (38(5)):729-736 doi:10.1111/echo.15039.

    PMID: 33847025
  11. 11

    A predictor for mitral valve repair in patient with rheumatic heart disease: the bending angle of anterior mitral leaflet.

    Fu JT, Popal MS, Jiao YQ, et al.

    Journal of thoracic disease 2018; (10(5)):2908-2915 doi:10.21037/jtd.2018.05.26.

    PMID: 29997956
  12. 12

    Evaluation of a focussed protocol for hand-held echocardiography and computer-assisted auscultation in detecting latent rheumatic heart disease in scholars.

    Zühlke LJ, Engel ME, Nkepu S, Mayosi BM

    Cardiology in the young 2016; (26(6)):1097-106 doi:10.1017/S1047951115001857.

    PMID: 26423122
  13. 13

    Changes in valvular regurgitation in mid-term follow-up of children with first attack acute rheumatic fever: first evaluation after the updated Jones criteria.

    Güler M, Laloğlu F, Ceviz N

    Cardiology in the young 2020; (30(3)):369-371 doi:10.1017/S1047951119003317.

    PMID: 31920190
  14. 14

    An 8-year single-centre experience of patients with subclinical rheumatic carditis.

    İrdem A, Ergin SO, Kaçar A, Dağdeviren FE

    Cardiology in the young 2024; (34(12)):2521-2527 doi:10.1017/S1047951124026453.

    PMID: 39358846

This guide to understanding echocardiograms for rheumatic fever is for educational purposes only. Always consult your child's pediatric cardiologist to interpret their specific echo report and treatment needs.

Get notified when new evidence is published on Rheumatic fever.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.