Rheumatic fever is a feverish illness, following infection with staphylococcus bacteria and caused by abnormal immunity to the bacteria, leading to systemic disease. Skin rash, subcutaneous nodules and a migrating arthritis are commonly seen. Involvement of the heart may lead to palpitations, chest pain, cardiac failure, myocarditis, and inflammation of the pericardium; murmurs may be heard and the electrocardiograph may show conduction abnormality. Sydenham's chorea may also be seen, with awkwardness, clumsiness, and involuntary movements. Late effects include chronic valve disease leading to stenosis or incompetence, particularly of the mitral or aortic valves. Such valve disease presents in young to middle age and may require surgical correction. Treatment of acute rheumatic fever includes bed rest, aspirin, and steroids. Penicillin treatment of streptococcal disease may prevent recurrence. Patients with valve damage require antibiotics during operations, especially dental and urinary tract surgery, to prevent bacterial endocarditis.