I remember visiting a small pediatric hospital in the late 1950s, where an entire floor was full of children suffering from rheumatic fever.

These days, more accurate diagnosis and aggressive treatment of strep throat infections have made rheumatic fever far less common than in the past. But my memory of that little hospital means it's likely that a fairly large number of middle-aged and older people alive today had rheumatic fever in childhood.

And these people, even if they have no symptoms today, should make an appointment to see a cardiologist. A proper diagnosis can lead to treatment that can prevent a stroke or other life-threatening problems.

Mitral stenosis - obstruction of blood flow from the left atrium to the left ventricle - is a common late complication of rheumatic fever. It often leads to atrial fibrillation (rapid, ineffective quivering of the left atrium) and blood clots in the left atrium. These clots can break off, travel to the brain, and cause a stroke. Atrial fibrillation greatly increases the risk of stroke.

Mitral stenosis can only be corrected by surgery, but atrial fibrillation can and must be treated either by attempting to convert fibrillation to a normal rhythm or with measures aimed at preventing blood-clot formation.

Many experts now believe that prevention of blood clots, rather than conversion to a normal heart rhythm, is the best approach to managing atrial fibrillation. Aspirin is used to prevent blood clots in some people with atrial fibrillation. When atrial fibrillation occurs in association with mitral stenosis, however, the most effective treatment is with the anticoagulant drug warfarin (Coumadin).

I recommend seeing a cardiologist because he or she is more likely than most other types of doctors to pick up the sometimes subtle murmurs and other abnormal heart sounds in people with rheumatic heart disease.