Acute rheumatic fever --> mitral regurge

Chronic rheumatic fever --> mitral stenosis

Child's presentation --> Rheumatic fever location of murmur (fourth intercostal space at the midclavicular line) --> mitral valve child has holosystolic murmur --> mitral valve incompetence vs diastolic murmur --> mitral valve stenosis

• Child with strep throat (throat culture and increased ASO titer) who presents with joint pain and a new 3/6 holosystolic murmur at the midclavicular line, most consistent with mitral valve regurgitation caused by rheumatic heart disease
• Rheumatic heart disease: JONES criteria (Joint pain, O for heart (endocarditis, myocarditis, pericarditis), subcutaneous Nodules, Erythema marginatum, and Sydenham chorea
• Systolic murmurs (left-sided): Aortic stenosis vs mitral regurgitation

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