Snapshot A 30-year-old woman presents to her physician’s office for palpitations. She reports that she previously was diagnosed with group A streptococcal pharyngitis as a child and was suspected to have rheumatic fever. She took antibiotics for it, but she was subsequently lost to follow-up. On physical exam, there is a holosystolic murmur at the apex, suspicious for mitral regurgitation. She is sent for further imaging to confirm the diagnosis. Introduction A consequence of rheumatic fever characterized by inflammation and scarring of the heart valves Epidemiology Demographics login to view 3 more bullets Location login to view 2 more bullets Risk factors login to view 3 more bullets ETIOLOGY Microbiology login to view 1 more bullet Pathogenesis login to view 9 more bullets Associated conditions login to view 1 more bullet Presentation Symptoms login to view 3 more bullets Physical exam login to view 12 more bullets Imaging Echocardiography login to view 5 more bullets Studies Labs login to view 1 more bullet Histology login to view 1 more bullet Differential Infective endocarditis login to view 4 more bullets Diagnosis Making the diagnosis login to view 1 more bullet Treatment Management approach login to view 8 more bullets Medical login to view 7 more bullets Operative login to view 6 more bullets Complications Aortic regurgitation Cardiac arrhythmias login to view 1 more bullet Heart failure Prognosis The early-stage may last for years and maybe asymptomatic Onset of symptoms usually occurs 10-20 years after acute rheumatic fever