What questions should be asked to a woman presenting with a history of Rheumatic (inflammatory) heart disease?

Key Medical Questions for Women with Rheumatic Heart Disease

When evaluating a woman with a history of rheumatic heart disease, a comprehensive set of specific questions should be asked to assess disease severity, complications, and impact on morbidity and mortality. 1

History of Rheumatic Fever and Initial Diagnosis

• Ask about history of acute rheumatic fever/carditis, including age at first episode and any recurrent episodes 1
• Inquire about previous echocardiographic findings suggestive of or diagnostic of rheumatic valvular disease 1
• Determine if the diagnosis was made through clinical findings or echocardiography, especially if there was no clear history of acute rheumatic fever 1

Valvular Involvement and Symptoms

• Ask about symptoms of valve disease, particularly:
  • Unusual dyspnea on light exertion 1
  • Recurrent dyspnea occurring in the supine position 1
  • Fluid retention 1
  • Palpitations or awareness of irregular heartbeat 1
  • Chest pain or discomfort 1
  • Syncope or presyncope 1
  • Fatigue or exercise intolerance 1

Complications and Associated Conditions

• Ask about history of heart failure symptoms or previous hospitalizations for heart failure 1
• Inquire about history of arrhythmias, particularly atrial fibrillation 1
• Ask about history of embolic events (stroke, TIA, peripheral emboli) 1
• Inquire about history of infective endocarditis 1
• Ask about history of pulmonary hypertension symptoms 2

Treatment History

• Determine if the patient is on penicillin prophylaxis to prevent recurrent rheumatic fever 1
  • Frequency and adherence to prophylactic regimen
  • Any allergies to antibiotics
• Ask about current cardiac medications (diuretics, beta-blockers, anticoagulants) 1, 2
• Inquire about previous cardiac interventions:
  • Balloon valvuloplasty 2
  • Surgical valve repair or replacement 1

Reproductive and Pregnancy History

• Ask about menstrual history and contraceptive use 1, 2
• Inquire about previous pregnancies and their outcomes 1, 2
• If previously pregnant:
  • Any cardiac complications during pregnancy (heart failure, arrhythmias) 1, 2
  • Mode of delivery (vaginal vs. cesarean) 2
  • Complications during postpartum period 2
• Ask about future pregnancy plans 1, 2

Impact on Daily Life and Quality of Life

• Ask about ability to perform routine and desired activities of daily living 1
• Inquire about any limitations in physical activity or exercise capacity 1
• Ask about impact on work, education, and social activities 2

Risk Factors and Comorbidities

• Ask about traditional cardiovascular risk factors (hypertension, diabetes, smoking, dyslipidemia) 3, 4
• Inquire about other autoimmune or rheumatologic conditions 3, 4
• Ask about history of other valvular disease etiologies (congenital, degenerative, infectious) 1
• Inquire about history of cerebrovascular disease 1
• Ask about history of peripheral arterial disease 1

Follow-up Care

• Ask about frequency of cardiac follow-up and most recent echocardiogram 1
• Inquire about adherence to medical therapy 1
• Ask about understanding of disease and need for endocarditis prophylaxis 1

Screening for Family Members

• Ask about family history of rheumatic heart disease 1
• Inquire if siblings or children have been screened for rheumatic heart disease 1, 5