During rheumatic fever in children

For rheumatism in children can be acute, protracted, continuously recurrent, sub-acute and latent. In severe in degree or another expressed exudative inflammatory component of rheumatism. Usually clinically clearly is the activity of the process. Dramatic shifts are observed in blood: the acceleration ROHE, neutrophilic leucocytosis, dysproteinemia, the improved difenilamina and sialic samples, increased titer of antistreptolysin, antigialuronidasy etc. during an acute attack of rheumatism (attacks) there are acute period (2 months. from the beginning of the attack) and the subacute period - the next 2-4 months. Some patients attack is delayed, and then talk about a protracted period. A new attack of rheumatic fever can be diagnosed in the case when from the moment of remitting preceding it was not less than 6 months. If exacerbation follow one another without such a period, a period considered to continuously relapsing.
When the latent period prevails granulomatous process. Such variant of the disease usually does not clinically manifests and is diagnosed only in retrospect, when the already formed the Vice valves. In the latent currents can be formed mitral insufficiency, as well as mitral stenosis. Moreover, the predominant mitral stenosis, requiring operative treatment (1st and 2nd group of vices, B. C. Petrovsky), in childhood is often the result of latent or sub-acute rheumatism and rarely formed in acute stroke (O., Solomatina).
Subacute (sluggish) for rheumatism characterized by the manifestation of intoxication - weakness, fatigue, arthralgia, subfebrile temperature, unpleasant feelings in the heart area. Similar symptoms are also at tonirovannoye, tuberculosis and other intoxication. The main difference subacute current rheumatism from infections and intoxications other etiologies are the nature and dynamics of cardiac changes. When infections and intoxications these changes are functional and are muted tones of the heart, sometimes the appearance of a third tone; systolic murmur soft, short, is not performed on the heart, somewhat separated from the first tone. For dynamic monitoring of the heart changes usually do not grow, but on the contrary, after rehabilitation of the source of infection are gradually decreasing. In cases of acute rheumatism changes on the part of the heart often increase. The noise gradually acquires the features of organic - becomes more clear, long-lasting, often blowing nature. Unlike functional, noise associated with heart colours (Fig. 15). Borders of heart in subacute during long remain normal. ECG long not to reveal characteristic changes. Often the differential diagnosis between subacute current rheumatism and functional changes in the cardiovascular system is possible only with long-term observation.
For reliable diagnosis of rheumatic fever requires the patient has one or more of the major clinical signs typical carditis, polyarthritis, chorea, rheumatic nodules, anularea rash [Jones (D. Jones), A. A. Kisel]. Additional symptoms of rheumatism (intoxication symptoms, laboratory and x-ray studies, data, power, phonocardiography) only confirm the diagnosis, specify the degree of the process activity.

Fig. 15. Phonocardiogram (a) and electrocardiogram (b) in the case of heart murmurs: left - functional systolic murmur; on the right, systolic murmur of organic nature with mitral valve insufficiency.