From the Guidelines
Rheumatic Heart Disease (RHD) is a chronic and debilitating condition that occurs as a result of acute rheumatic fever, leading to valvular heart disease and potentially causing atrial fibrillation, heart failure, and other complications.
Definition and Pathophysiology
- RHD is an autoimmune disease that follows a group A β‑haemolytic streptococcal (GAS) infection of the throat (streptococcal pharyngitis) 1.
- After recovery from the initial episode of RF, 60–65% of patients develop valvular heart disease, which can progress to RHD if left untreated or if recurrences occur 1.
Epidemiology
- The global burden of RHD is estimated to be around 15.6–19.6 million existing cases, with an approximate global incidence of 282,000 new cases per year 1.
- RHD is a major public health problem in developing countries, where it predominantly affects young adults, and is also present in industrialized countries due to immigration and sequelae of rheumatic fever in older patients 1.
Diagnosis and Treatment
- Echocardiography has proven to be more sensitive and specific than auscultation for diagnosing RHD, and is now the standard for evaluating valve structure and function 1.
- Optimal medical care for RHD includes the use of diuretics, angiotensin-converting-enzyme inhibitors, and β-blockers, as well as access to anticoagulant drugs and regular diagnostic monitoring 1.
- Secondary prophylaxis in the form of penicillin injections every 3–4 weeks is the only cost-effective approach to controlling RHD, and can prevent recurrent attacks of group A streptococcal infection that cause ARF and worsen RHD 1.
From the Research
Definition and Cause of Rheumatic Heart Disease (RHD)
- Rheumatic heart disease (RHD) is a chronic valvular disease resulting from severe or repetitive episodes of acute rheumatic fever (ARF), an autoimmune response to group A Streptococcus infection 2, 3, 4.
- It is the only preventable cardiovascular disease that causes significant morbidity and mortality, particularly in low- and middle-income countries 5.
Burden and Impact of RHD
- RHD generates relatively little attention from the medical and science communities, despite imposing a major cardiovascular morbidity/mortality burden 2.
- The disease accounts for 1.6% of all cardiovascular deaths, resulting in 306,000 deaths yearly, with a much higher contribution in low- and middle-income countries 6.
- RHD can result in severe health adverse outcomes, including heart failure, arrhythmias, stroke, and embolisms, and ultimately premature death 6.
Diagnosis and Management of RHD
- Early clinical diagnosis is key, and the updated Jones criteria increase the likelihood of diagnosis in endemic settings 5.
- The mainstay of rheumatic heart valve disease (RHVD) is a thorough clinical and echocardiographic investigation, while severe disease is managed with medical, interventional, and surgical treatment 5.
- Long-term penicillin-based treatment and surgery remain the backbone of a RHD control program in the absence of an effective vaccine 4.
Prevention and Control of RHD
- Prevention of RHD is possible through improved social circumstances, early diagnosis, and effective delivery of antibiotic prophylaxis 2.
- Early identification through ultrasound of silent, subclinical rheumatic valve lesions could provide an opportunity for early intervention 2.
- A better understanding of the immunogenic determinants of the disease may provide potential routes to vaccine development and other novel therapies 2.