• It is characterised by damage of heart structures by Rheumatic fever.
  • Generally affected cardiac structures are mitral and aortic valves. This can results in either severe narrowing or severe leak of the valves. This can be detected either as an emergency or can be detected on routine examination.
  • Mitral valve is more affected as compared to aortic valve.
  • Effect of rheumatic fever on the heart (rheumatic heart disease) can be avoided by treating or preventing rheumatic fever.
  • Children with age group between 5 years to 15 years are prone for rheumatic fever and its consequences. This is generally seen with recurrent throat infection by bacteria known as Streptococcus.

Clinical presentation

  • Symptoms with RHD vary depending on its onset whether acute or chronic.
  • If mitral and aortic valves are affected acutely then child may have shortness of breath as predominant symptoms even in resting phase as well.
  • If heart walls (myocardium) or outer covering of the heart (pericardium) are affected then children may have pain in chest.
  • Other clinical feature that child can have joint pain etc.

Diagnosing of Rheumatic Heart Disease

  • For diagnosing RHD, clinical features (symptoms and signs) can be noticed on asking history and examining the child.
  • On examination, doctor can heart an abnormal heart sound (murmur), can see affected joints etc.
  • Modified Jone’s criteria is used for diagnosing the Rheumatic Fever.
  • Lab investigations like blood test, chest x ray, ECG, throat culture are advised for diagnosis.
  • Confirmatory test is by doing “echocardiogram of the child”.

Treatment of RHD

  • This is in the form of medicines, cardiac interventions or by open heart surgery.

Drug Treatment:

  • After assessment, antibiotic treatment is advised as preventive measures for treating throat infection.
  • If required then anti-inflammatory medicines for treating joint related problems like pain etc.
  • Sometimes, bed rest is also advised depending on the severity of RHD.
  • If Rheumatic fever is diagnosed, then child should be in follow up with paediatric cardiologist.
  • If RHD is confirmed then child needs to take medicines for a long duration for preventing further damage to heart structures.

Cardiac Intervention:

  • If mitral valve is obstructed then cardiac intervention in the form of balloon mitral valvuloplasty (BMV) can be planned.

Open Heart Surgery:

  • If valve is not suitable for BMV, then mitral or aortic valve can be replaced by an artificial valve by open heart surgery (MVR/DVR). This is seen in Chronic RHD.

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