We report our 8-year experience with the resurgence of acute rheumatic fever during the years 1985 through 1992. The records of 274 confirmed cases referred to Primary Children's Medical Center were reviewed. The clinical features including the presence of the Jones criteria, demographic data, preceding streptococcal infection, and the use of echocardiographic studies were tabulated and assessed. Patients came predominantly (84%) from middle-class families with access to medical care. Only 46 patients (17%) sought medical attention for a preceding sore throat. Carditis evident by auscultation was the dominant major manifestation in 68% of the cases. Echocardiography demonstrated mitral regurgitation that was not audible in 15 (47%) of 32 patients who had only polyarthritis at onset and in 30 (57%) of the 53 who had pure chorea. The incidence of acute rheumatic fever has been declining since the peak of the outbreak in 1985 but is continuing in the intermountain area at rates comparable to those of the 1960s. (J PEDIATR 1994;124:9-16)