Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits

Table 1

Doppler and morphological findings in rheumatic valvulitis.

Doppler findings	Morphological findings
(i) Pathological mitral regurgitation (all 4 criteria should be met)	(i) Acute mitral valve changes
(1) Seen in at least 2 views	(1) Annular dilation
(2) Jet length ≥ 2 cm in at least 1 view	(2) Chordal elongation
(3) Peak velocity > 3 m/s	(3) Anterior/posterior leaflet tip prolapse
(4) Pansystolic jet in at least 1 envelope	(4) Chordal rupture
(ii) Pathological aortic regurgitation (all 4 criteria should be met)	(5) Beading/nodularity of leaflet tips
(1) Seen in at least 2 views	(ii) Chronic mitral valve changes
(2) Jet length ≥ 1 cm in at least 1 view	(1) Leaflet thickening
(3) Peak velocity > 3 m/s	(2) Chordal thickening and fusion
(4) Pandiastolic jet in at least 1 envelope	(3) Restricted leaflet motion
	(4) Calcification
	(iii) Aortic valve changes in acute or chronic carditis
	(1) Irregular or focal leaflet thickening
	(2) Restricted leaflet motion
	(3) Leaflet prolapse
	(4) Coaptation defect

Note. Reprinted from “Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association” by Gewitz et al. [5].