What are the electrocardiogram (ECG) findings in rheumatic fever (RF) with carditis?

From the Guidelines

Rheumatic fever carditis is characterized by several ECG findings, most notably a prolonged PR interval, which is a major criterion for diagnosis, as stated in the revised Jones criteria 1. The ECG findings in rheumatic fever carditis can be summarized as follows:

• Prolongation of the PR interval (first-degree AV block) is the most common ECG abnormality, occurring in approximately 30% of patients with rheumatic carditis, reflecting inflammation affecting the AV node and conduction system.
• Other conduction disturbances, such as second-degree or complete heart block, may also be seen in severe cases.
• Sinus tachycardia is frequently present, reflecting the inflammatory state and sometimes heart failure.
• ST segment and T wave abnormalities are common, representing myocardial inflammation.
• In patients with significant valvular involvement, particularly mitral regurgitation, ECG may show left atrial enlargement (P mitrale).
• With more advanced disease, ventricular hypertrophy patterns may develop, with left ventricular hypertrophy seen in cases of aortic regurgitation or mitral regurgitation, and right ventricular hypertrophy in cases with pulmonary hypertension. These ECG changes reflect the underlying inflammatory process affecting the heart's electrical conduction system and the hemodynamic consequences of valvular damage, which is the hallmark of rheumatic heart disease, as supported by the revised Jones criteria 1 and the American Heart Association's scientific statement 1. The diagnosis of rheumatic fever carditis should be based on the revised Jones criteria, which include ECG findings as a minor criterion, in addition to clinical and echocardiographic evidence of carditis 1.

From the Research

Rheumatic Fever Carditis ECG Findings

There are no specific ECG findings mentioned in the provided studies for rheumatic fever carditis. However, the studies discuss the management and treatment of acute rheumatic fever and rheumatic heart disease.

Management and Treatment

• The use of anti-inflammatory agents such as aspirin, corticosteroids, and immunoglobulin for preventing or reducing further heart valve damage in patients with acute rheumatic fever is discussed in the studies 2, 3.
• The studies suggest that there is no significant difference in the risk of cardiac disease at one year between the corticosteroid-treated and aspirin-treated groups 2, 3.
• The use of corticosteroids or intravenous immunoglobulins to reduce the risk of heart valve lesions in patients with acute rheumatic fever is not supported by the evidence 2, 3.
• Secondary prophylaxis with benzathine penicillin G has been shown to decrease the incidence of rheumatic heart disease and is key to rheumatic heart disease control 4, 5.
• The Indian Academy of Pediatrics has formulated guidelines for the management of acute rheumatic fever and rheumatic heart disease, including the use of aspirin with or without steroids for 12 weeks to control the inflammatory process 6.

Diagnosis and Prevention

• The diagnosis of acute rheumatic fever is based on clinical criteria, including the 2015 modified Jones criteria 4.
• Timely treatment of group A streptococcal infection can prevent acute rheumatic fever, and penicillin prophylaxis can prevent recurrence of acute rheumatic fever 4, 5.
• Prevention of recurrent acute rheumatic fever is the most effective way to prevent rheumatic heart disease 4.