The Pattern of Symptoms, Pre-Treatment Interval, and Prognosis of Acute Rheumatic Fever
Authors: ALVAN R. FEINSTEIN
Journal: Annals of Internal Medicine (1962)

Article1 October 1962The Pattern of Symptoms, Pre-Treatment Interval, and Prognosis of Acute Rheumatic FeverALVAN R. FEINSTEIN, M.D., JUANITA G. ZAGALA, M.D., MARIO SPAGNUOLO, M.D.ALVAN R. FEINSTEIN, M.D.Search for more papers by this author, JUANITA G. ZAGALA, M.D.Search for more papers by this author, MARIO SPAGNUOLO, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-57-4-563 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn a recent re-appraisal of the clinical patterns of acute rheumatic fever (1), we decided to examine the now traditional belief that residual heart disease is prevented by early treatment. Inspected grossly, the data for first attacks of rheumatic fever showed residual heart disease in 53 (25 per cent) of 209 patients who began treatment within the first 2 weeks after onset of symptoms and in 38 (69 per cent) of 55 patients who began treatment after the first 2 weeks. This highly significant difference seemed to be a clear demonstration that early treatment was of definite value.When the...References1. FEINSTEINSPAGNUOLO ARM: The clinical patterns of acute rheumatic fever: a reappraisal. Medicine (Balt.) In press. Google Scholar2. American Heart Association. Report of Committee on Standards and Criteria for Programs of Care of the Council on Rheumatic Fever: Jones criteria (modified) for guidance in diagnosis of rheumatic fever. Mod. Conc. Cardiov. Dis. 24: 291, 1955. MedlineGoogle Scholar3. MCKEE MH: Heart sounds in normal children. Amer. Heart J. 16: 79, 1938. CrossrefGoogle Scholar4. LESSOFBRIDGEN MW: Systolic murmurs in healthy children and in children with rheumatic fever. Lancet 273: 673, 1957. CrossrefMedlineGoogle Scholar5. FEINSTEIN AR: The stethoscope: a source of diagnostic aid and conceptual errors in rheumatic heart disease. J. Chron. Dis. 11: 91, 1960. CrossrefMedlineGoogle Scholar6. FEINSTEIN AR: Standards, stethoscopes, steroids and statistics. The problem of evaluating treatment in acute rheumatic fever. Pediatrics 27: 819, 1961. MedlineGoogle Scholar7. KEITH JD: Overstimulation of the vagus nerve in rheumatic fever. Quart. J. Med. 7: 29, 1938. Google Scholar8. WYCKOFFDEGRAFFPARENT JACS: The relationship of auriculoventricular conduction time in rheumatic fever to salicylate therapy. Amer. Heart J. 5: 568, 1929-30. CrossrefGoogle Scholar9. SHNIER MH: The Wenckebach phenomenon and auricular-ventricular dissociation in childhood. Arch. Dis. Child. 33: 246, 1958. CrossrefMedlineGoogle Scholar10. REYERSBACHKUTTNER GAG: Studies on the auriculo-ventricular conduction time of normal children and of rheumatic children without signs of rheumatic activity. Amer. Heart J. 20: 573, 1940. CrossrefGoogle Scholar11. MASSELLFYLERROY BFDCSB: The clinical picture of rheumatic fever. Diagnosis, immediate prognosis, course and therapeutic implications. Amer. J. Cardiol. 1: 436, 1958. CrossrefMedlineGoogle Scholar12. FEINSTEINDIMASSA ARR: The prognostic significance of valvular involvement in acute rheumatic fever. New Engl. J. Med. 260: 1001, 1959. CrossrefMedlineGoogle Scholar13. BOONELEVINE JASA: The prognosis in "potential rheumatic heart disease" and "rheumatic mitral insufficiency." Amer. J. Med. Sci. 195: 764, 1938. CrossrefGoogle Scholar14. BROWNWOLFF MGL: Recovery from acute rheumatic fever without permanent heart damage. New Engl. J. Med. 223: 242, 1940. CrossrefGoogle Scholar15. ENGLEMANHOLLISTERKOLB EPLEFO: Sequelae of rheumatic fever in men: four-to-eight-year follow-up study. JAMA 155: 1134, 1954. CrossrefMedlineGoogle Scholar16. . A comparison of the effect of prednisone and acetylsalicylic acid on the incidence of residual rheumatic heart disease. New Engl. J. Med. 262: 895, 1960. CrossrefMedlineGoogle Scholar17. United Kingdom and United States Joint Report. The evolution of rheumatic heart disease in children. Five-year report of a cooperative clinical trial of ACTH, cortisone and aspirin. Circulation 22: 503, 1960. CrossrefGoogle Scholar18. MASSELL BF: ACTH and cortisone therapy of rheumatic fever and rheumatic carditis. New Engl. J. Med. 251: 263, 1954. CrossrefMedlineGoogle Scholar19. GREENMANWEIGARDMATEERDANOWSKI LFAFMTS: Cortisone therapy of initial attacks of rheumatic carditis. Amer. J. Dis. Child. 89: 426, 1955. Google Scholar20. ROYMASSELL JBBF: Comparison of large and small doses of hormones in treatment of acute rheumatic carditis. Circulation 14: 44, 1956. CrossrefMedlineGoogle Scholar21. MASSELLJHAVERICZONICZER BFSG: Therapy and other factors influencing the course of rheumatic heart disease. (Abstract) Circulation 20: 737, 1959. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: ALVAN R. FEINSTEIN, M.D.; JUANITA G. ZAGALA, M.D.; MARIO SPAGNUOLO, M.D.Affiliations: Irvington-on-Hudson, New YorkFrom Irvington House, Irvington-on-Hudson, New York, and the Department of Medicine, New York University School of Medicine, New York, New York.Supported in part by grants from Parke, Davis and Company, the National Heart Institute (H 1595 C7), the American Heart Association, the New York Heart Association, and the Sullivan County Heart Chapter.Requests for reprints should be addressed to Alvan R. Feinstein, M.D., Department of Medicine, Yale University School of Medicine, 789 Howard Avenue, New Haven 11, Connecticut. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byRheumatic FeverAcute rheumatic feverPrevention of heart failureAcute rheumatic fever in Karachi, PakistanModern concepts in acute rheumatic fever—A reviewBiographische Aspekte der entzündlichen KlappeninsuffizienzThe prognosis of acute rheumatic feverRheumatism and Arthritis Review of American and English Literature of Recent Years (Sixteenth Rheumatism Review)CHARLEY J. SMYTH, M.D., F.A.C.P., ROGER L. BLACK, M.D., CHARLES CHRISTIAN, M.D., MACK L. CLAYTON, M.D., F.A.C.S., DONALD F. HILL, M.D., F.A.C.P., JOSEPH LEE HOLLANDER, M.D., F.A.C.P., WILLIAM M. MIKKELSEN, M.D., F.A.C.P., MAX M. MONTGOMERY, M.D., F.A.C.P., CARL M. PEARSON, M.D., F.A.C.P., HUGH A. SMYTHE, M.D., F.R.C.P. (C), L. EMMERSON WARD, M.D., F.A.C.P., HOWARD J. WEINBERGER, M.D., F.A.C.P.Scientific Methodology in Clinical Medicine II. Classification of Human Disease by Clinical BehaviorALVAN R. FEINSTEIN, M.D.Symptomatic Patterns, Biologic Behavior, and Prognosis in Cancer of the Lung Practical Application of Boolean Algebra and Clinical TaxonomyALVAN R. FEINSTEIN, M.D. 1 October 1962Volume 57, Issue 4Page: 563-571KeywordsArthritisCardiovascular therapyHeartMyocarditisPathogenesisPatientsRheumatic fever ePublished: 1 December 2008 Issue Published: 1 October 1962 PDF downloadLoading ...