Rheumatic Heart Disease (RHD)
Description
Rheumatic Heart Disease (RHD) represents a spectrum of cardiac lesions arising from Acute Rheumatic Fever (ARF). These include:
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Pericarditis
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Myocarditis
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Valvulitis during the acute ARF episode
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Chronic valvular deformities developing over years following one or more ARF episodes
The most common affected valves are:
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Mitral valve: Mitral regurgitation and mitral stenosis
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Aortic valve: Aortic regurgitation and aortic stenosis
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Tricuspid valve: Tricuspid regurgitation and stenosis (less common)
Signs and Symptoms
| System | Findings |
|---|---|
| Cardiac | Heart failure symptoms resulting from valvular insufficiency or stenosis (e.g., dyspnoea, fatigue, exercise intolerance, orthopnoea) |
Treatment
Medical Management
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Prevention of ARF by eliminating GAS pharyngitis (as previously outlined)
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Supportive treatment of congestive cardiac failure (CCF)
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Prevention of recurrent ARF using long-term secondary prophylaxis
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Continuous monitoring for complications and sequelae of chronic RHD
Surgical Management
Indicated in patients with:
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Persistent congestive cardiac failure despite optimal medical therapy
OR -
Worsening clinical status despite aggressive RHD medical therapy
Goal: To reduce valve insufficiency or relieve stenosis
Complications of Rheumatic Heart Disease
| Complication | Description |
|---|---|
| Atrial arrhythmias | Commonly atrial fibrillation due to atrial dilatation |
| Pulmonary oedema | From acute decompensated heart failure |
| Recurrent pulmonary emboli | Due to stasis in dilated chambers, especially with AF |
| Infective endocarditis | Damaged valves predispose to bacterial colonisation |
| Intracardiac thrombus formation | Especially in atrial fibrillation or severely dilated chambers |
| Systemic embolism | Stroke or peripheral arterial embolisation from cardiac thrombi |