Medical Q&As

Rheumatic fever - antibiotics needed?

It is suspected that I had rheumatic fever as a child but it was never confirmed and I cannot find any medical records. Is there any way to confirm that I did or did not have it? I am a 37-year-old female and have not experienced any symptoms. I take antibiotics prior to every dental visit based on the suspicion that I once had it.

Rheumatic fever is rarely seen today and would have been relatively uncommon even when you were a child. One of the serious side effects of rheumatic fever is that the heart valves can be affected. Dental treatment presents a particular risk to such people because bacteria may be introduced into the blood during the course of a dental procedure. Such bacteria could then lodge in the previously damaged heart valve and cause deterioration in cardiac function. Since you are a healthy thirty seven year old woman I seriously doubt that you have a valvular problem with your heart. If you had a problem with a heart valve then antibiotic prophylaxis before a dental procedure would be strongly advised. However, a vague possible history of rheumatic fever in the absence of a valvular defect does not require antibiotic prophylaxis. There are antibody tests for rheumatic fever but I donít think such antibodies would be detectable in your case so many years later. I think you need to establish that your heart is healthy, which I strongly suspect it is. Simply listening to your chest with a stethoscope would give some information. If this simple examination was followed up with an ultrasound study of the heart this would prove conclusively that your valves and heart chambers are normal. I fully understand why doctors and dentists would be ultra cautious in dealing with people who have rheumatic heart disease because the consequences of bacterial infection of the heart can be quite devastating. However, a vague possible history of rheumatic fever in the absence of heart disease does not require ongoing prophylaxis for the rest of your life.