A Review on Rheumatic Heart Disease

Rheumatic heart disease (RHD) is a condition that damages the valves of the heart, occurring in pediatrics and young adults. Group A Streptococcus (GAS) is the causative agent of RHD that results in the inflammation in the joints (arthritis), heart, and blood vessels. The exact pathogenesis of rheumatic heart disease is not fully understood. The clinical manifestations include fatigue, weakness, chest discomfort, and shortness of breath. Potential complications comprise heart failure, permanent heart damage, acute and chronic heart valve disease, and bacterial endocarditis. The differential diagnosis of RHD are endocarditis, viral myocarditis, and prolapse of the mitral valve. The diagnosis relies on the assessment criteria i.e., Modified Jones Criteria for rheumatic fever and World Health Federation (WHF) Echocardiographic Diagnostic Criteria for rheumatic heart disease. Treatment with Benzylpenicillin is the first-line drug of choice for rheumatic heart disease, followed by oral Penicillin V and Erythromycin. Based on the Indian Pediatrics and World Health Organization guidelines, children who are allergic to Penicillin can be recommended with Azithromycin or Erythromycin. This condition can be prevented by limiting the exposure to infection in high-risk regions, treating with appropriate antibiotics, preventing recurrence of infections and complications. This chapter focuses on the rheumatic heart disease, its epidemiology, the clinical presentations and its management.