Keywords: Acute rheumatic fever, silent rheumatic carditis, mitral valve prolapse, pre-participation sports examination, pediatric cardiology, family medicine, asymptomatic heart disease, cardiac risk assessment, early diagnosis, primary care referral

Background:

Early detection of hidden cardiac conditions in children is a critical challenge in primary care, especially in areas with limited access to specialist services. Acute rheumatic fever (ARF) may develop silently after streptococcal infections and can cause serious cardiac damage if left undiagnosed. Primary care physicians, including those working in rural settings, play a vital role in identifying these cases during routine check-ups such as pre-participation sports examinations.

Aim of the case report:

To demonstrate the importance of primary care physicians in detecting silent rheumatic carditis during routine sports fitness evaluations and to highlight the impact of early referral on patient outcomes.

Case report:

A previously healthy child presented to a family physician for a routine sports clearance evaluation. The child was asymptomatic, with a normal physical examination and no recent history of illness. The family mentioned a past pattern of frequent upper respiratory infections that were not evaluated medically. Given the clinical context and history, the physician referred the child to pediatric cardiology for further evaluation. Investigations revealed elevated ASO levels and mitral valve prolapse (MVP), consistent with a previous silent episode of ARF. Treatment and secondary prophylaxis were initiated.

Conclusions:

This case highlights how early suspicion and referral by a family physician led to the detection of a significant but clinically silent cardiac condition. Identifying such cases during routine evaluations is especially important in rural or underserved areas, where specialist access is often delayed.This case underlines the preventive role of primary care in reducing long-term complications from undiagnosed rheumatic carditis.