The classic dramatic clinical presentation of acute rheumatic fever (ARF), with high fever, severe carditis and acute polyarthritis, is changing to an asymptomatic, milder form. The cardiac damage potential of the disease remains high. It is the responsibility of the primary care nurse practitioner to 1) provide primary prevention of ARF through appropriate treatment of streptococcal pharyngitis; 2) be cognizant of the manifestations of the disease; and 3) provide secondary prevention of subsequent attacks through prophylaxis.