When should I consider referring a patient with rheumatic fever to a specialist?

Consider referring a patient with rheumatic fever to a specialist (such as a cardiologist or rheumatologist) if there are signs of heart valve involvement or complications. Rheumatic fever can cause valvular heart disease, so referral is particularly important if echocardiography shows moderate or severe valve disease, or if the patient has symptoms such as breathlessness, angina, or syncope related to valve disease. Referral should also be considered if there is evidence of heart failure or arrhythmias associated with valvular damage.

In addition, urgent referral is warranted if the patient presents with severe symptoms or complications that require specialist assessment and management.

While the provided guidelines do not explicitly detail rheumatic fever referral criteria, they emphasize referral to specialists for valvular heart disease and inflammatory arthritis, which are relevant to rheumatic fever management.