There are two clinical forms of rheumatic endocarditis. 

  1. Recent endocarditits 
  2. Recurrent endocarditis 

Recent endocarditis 

Clinical symptoms appear 8 to 10 days after the rheumatic attack.  

  1. High fever (rises and falls periodically) 
  2. Extreme fatigue 
  3. Rhythm disruptions, tachycardia, (palpitations) 
  4. A feeling of heaviness and pain in the precordium 
  5. Dyspnea (difficulties breathing) 

Both forms, depending on their evolution may be acute, subacute  and latent. 

All of these symptoms are actually not characteristic of endocarditis but of the myocarditis which accompanies it. If the precordial aches are more severe, the pericardium may have been affected. If the pain is similarly located as the pains of stenocardia, then they could be due to rheumatic coronaritis.  

As a result of these processes, the valves may become edematous and later on fibrous. Following treatment the valves may heal completely, or form cicatrices and never heal over properly.

The latter may cause: 

Mitral insufficiency

This may occur 3-6 weeks later, and is characterized by a high tonality holosystolic sound which can be heard as the beat felt over the apex of the heart in the point of maximal impulse in the direction of the left axilla. It must not be confused with the systolic sound that can be heard at the apex of the heart from the very first days following the rheumatic attack and is related to the dilation of the heart and the loss of muscular tonus, as a consequence of the accompanying myocarditis.  

Aortic insufficiency

In order for this condition to develop, it may take 6 weeks up to 2-3 months to develop. It is characterized by a diastolic sound of low of medium high tonality, which begin immediately following the second sound. The is aspirated in decrescendo and is spread in the direction of the apex of the heart, with aspirated, decrescendo character. 

Mitral stenosis

Mitral stenosis requires a longer period of time over which to develop, usually 4 to 6 months. In order for this condition to manifest certain acoustic phenomena related to the heart rhythm, it may take even longer, up to 2 years. It may begin as a short mesodiastolic sound at the apex of the heart and then transform into presystolic strain and diastolic murmur. More common phenomena include tachycardia, sinus bradycardia or extrasystolic arrhythmia. At times a galloping rhythm may be distinguished, which must not be confused with the physiological third physiological sound present in younger individuals.  

Recurrent endocarditis

This type of endocarditis is present in patients with pre-existing heart defects and who have suffered once or many times from rheumatic endocarditis. And in this way, a new verrucous process can be overlayed over the sclerotic valves and pre-existing defects; the new process is localized not only over the damaged valves, but also over the healthy ones.
The disease develops in waves, with intermittent periods of aggravation and relief. Depending on the form of endocarditis the fever may be high or subfebrile, and the palpitations, tachycardia, feeling of heaviness and precordial pain may increase.  

In periods when the acute nature of the disease returns, the laboratorial changes become more pronounced.

In addition to the above, each time the disease returns the myocardium becomes gradually more susceptible to damage, and this may cause patients to suffer from cardiac insufficiency, a lot faster than a heart defect. Mitral defects are more common. The mitral valve is affected in 85% of patients with rheumatic defects. 

Medically Reviewed by a doctor on 28 Mar 2018
Medical Author: Dr. med. Diana Hysi