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James W. Grifone, M.D.; J. Roderick Kitchell, M.D.
JAMA. 1954;154(16):1341-1343. doi:10.1001/jama.1954.02940500021008.
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Rheumatic activity is not often considered in dealing with patients over 60 years of age, although evidences of old rheumatic involvement of the heart are common findings at autopsy in this age group. Acute rheumatic heart disease is usually a disease of children and young adults. Cohn and Lingg1 made a study of 12,000 patients in New York City who had rheumatic heart disease. They found that only 16% of these patients were in the age groups past 45, and only 3% of the total 12,000 were first affected after the age of 45. Their statistics indicated that the mean age of onset in men was 14.5 ± 0.3 years and in women it was 15.0 ± 0.3 years. Children and young adults often present the typical "textbook" picture of fever, migratory polyarthritis, carditis, electrocardiographic changes, leukocytosis, and increased sedimentation rate. Older patients may not present all these signs,


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