The clinical profile of the initial attack of acute rheumatic fever was studied prospectively in 86 patients, who were admitted to the medical and pediatric units of Basrah Republican Hospital (Teaching), over a period of 2 years. The most common features of the initial attack of ARF were fever, arthritis, and high erythrocyte sedimentation rate. Arthritis was found in 79 patients (91.9%), carditis in 40 patients (46.5%), and chorea in one patient (1.2%). Erythema marginatum and subcutaneous nodules were not observed. No mortality was recorded in this series. The findings of this study show that the clinical profile of the initial attack of acute rheumatic fever in Iraq does not differ substantially from that in the West or in the Third World countries. The objectives of this paper are to report the clinical profile of the first attack of ARF in patients from Basrah, Iraq, and to compare the profile with that prevalent in the West and in other countries. Patients and MethodsThis prospective study included patients with initial attack of ARF who were admitted to pediatric and medical units of Basrah Republican Hospital (Teaching) over a period of 2 years from January 1984 to December 1985. Those with previous history of ARF were excluded.The diagnosis of ARF was made by applying the revised Jones criteria. 6The diagnosis and severity of carditis were assessed as follows: 1. Mild carditis was diagnosed when one or more of the following criteria were present for the first time: a. persistent elevation of sleeping pulse rate in the presence of at least one of the following murmurs; b. significant apical systolic murmur which conducted well to axilla, scored at least grade 2 intensity on a scale of 6, and did not change substantially with respiration or position; c. apical mid-diastolic murmur; d. basal diastolic murmur. 2. Moderate carditis was diagnosed when radiologic evidence of cardiomegaly coexisted with one or more of