Tachycardia fever

There may be a sudden onset of pain, swelling and stiffness in one or more joints, with fever, sweating and tachycardia, or the onset may be insidious with fatigue, malaise and loss of weight. Fever is usual in acute attacks but variable in degree and duration and much influenced by the administration of salicylates which have a marked antipyretic effect. Sweating may be profuse and tends to be accentuated by salicylates. Other accompaniments of fever, such as anorexia, furred tongue, constipation and albuminuria, are often present. Tachycardia tends to be out of proportiontothe degree of fever and may persist after the latter has settled. The sleeping pulse rate will differentiate tachycardia due to anxiety or excitement. And this observation is exceedingly useful in deciding when more physical activity can be permitted.

Valvular heart disease

There is no doubt about the close relationship of chorea to rheumatic fever in many cases. The majority of children with chorea either show evidence of rheumatic valvular disease or develop such evidence subsequently. The clinical features suggest involvement of the basal ganglia, and when the opportunity for study has occurred changes suggesting encephalitis in this region of the brain have been found, although they are surprisingly mild. For this reason the clinical features of chorea are surprisingly mild. For this reason the clinical features of chorea are described under the Diseases of the Nervous System.

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