An important contribution of echo-Doppler could reside in the identification of the group of patients who do not show clinical cardiac involvement during an attack of RF. Although exclusion of the diagnosis of carditis can be significantly facilitated by employing echo-Doppler as a primary diagnostic modality. Use of serial echocardiographic studies has been proposed to facilitate identification of organic valvular involvement.It is possible that these patients had suffered from subclinical carditis in the index attack which was too mild to be detected clinically. Echo-Doppler is likely to identify this subset, which would support a somewhat longer duration of secondary prophylaxis. There is no clear evidence for this scenario, however, and the American Heart Association (AHA) expert group does not presently favor the diagnosis of carditis based on Doppler echocardiography in absence of clinical criteria to support the diagnosis.Finally, if echocardiography is used as a primary Diagnostic modality, perhaps the epidemiological face of RFcan be completely altered.