INITIAL ATTACKS OF RHEUMATIC FEVER IN PATIENTS OVER SIXTY YEARS OF AGE

Abstract

Within the past few years initial attacks of rheumatic fever have been observed with surprising frequency in the Boston City Hospital in patients past middle life, and in six instances in patients over 60 years of age. Since initial attacks of rheumatic fever are generally considered to occur in childhood or in early adult life, such a diagnosis in patients past middle life necessarily requires rigid criteria; however, when one encounters in an elderly patient with polyarthritis electrocardiographic changes consistent with rheumatic fever, in addition to other rheumatic manifestations, the diagnosis should be strongly entertained. In cases of elderly patients with polyarthritis the diagnosis of rheumatic fever is often dismissed largely because of the age of the patient. For this reason and because initial attacks of rheumatic fever are rarely described in elderly people, we are reporting the six cases in which we believe the first attack occurred after the