cardiac involvement in rheumatic fever. The rheumatic process affects the endocardium, myocardium, and pericardium. Myocarditis or myocarditis combined with endocarditis or pericarditis is most common. Pancarditis—inflammation of the entire heart—occurring mainly in children, is not characteristic of present-day rheumatic carditis.

The basis of rheumatic carditis is a nonspecific exudative inflammation and the disorganization of cardiac connective tissue. Other stages are the formation of rheumatic nodules, the subsequent cicatrization of the nodules, and the development of heart diseases and cardiosclerosis. Symptoms of rheumatic carditis include pain in the region of the heart, palpitation of the heart, arrhythmia, debility, and dyspnea after mild physical exertion. Examination reveals a widening of the margins of the heart, a muffled heartbeat, the presence of heart murmurs, and changes in the blood and the electrocardiogram.

Rheumatic carditis may be diffuse or focal and is accompanied by correspondingly greater or lesser manifestations of cardiac insufficiency. Treatment is aimed at decreasing inflammation and correcting the cardiac insufficiency.