From the Guidelines
Cardiac rheumatic refers to heart damage caused by rheumatic fever, a condition that develops after an untreated streptococcal infection like strep throat, leading to rheumatic heart disease, which can cause significant morbidity and mortality if left untreated or poorly managed. This inflammatory disease primarily affects the heart valves, causing scarring and deformity, with the mitral valve being most commonly affected, followed by the aortic valve, as noted in the 2013 position statement of the World Heart Federation on the prevention and control of rheumatic heart disease 1. Symptoms may include heart murmurs, shortness of breath, chest pain, and irregular heartbeat. Prevention involves prompt treatment of strep infections with antibiotics like penicillin. For those who have had rheumatic fever, long-term antibiotic prophylaxis (typically penicillin G benzathine injections every 3-4 weeks or daily oral penicillin V) is recommended to prevent recurrence, with the duration of prophylaxis depending on whether heart damage is present, ranging from 5 years to lifelong, as suggested by the 2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease 1.
The diagnosis of rheumatic heart disease can be made using echocardiography, which is vastly superior to auscultation for detecting RHD, according to the 2023 guidelines 1. The guidelines provide revised minimum echocardiographic criteria for the definitive diagnosis of RHD, a new classification of RHD dependent on the risk of disease progression, and management recommendations for early-stage RHD. The use of hand-held echocardiography and task sharing for active case finding in resource-limited settings is also recommended, as noted in the 2023 guidelines 1.
Key points to consider in the management of cardiac rheumatic disease include:
- Prompt treatment of strep infections with antibiotics to prevent rheumatic fever
- Long-term antibiotic prophylaxis for those who have had rheumatic fever to prevent recurrence
- Echocardiography as the preferred method for diagnosing RHD
- Management of early-stage RHD according to the 2023 World Heart Federation guidelines
- Consideration of task sharing and hand-held echocardiography for active case finding in resource-limited settings, as recommended by the 2023 guidelines 1.
Overall, cardiac rheumatic disease is a significant cause of morbidity and mortality worldwide, particularly in low-income and middle-income countries, and prompt diagnosis and treatment are essential to prevent long-term complications and improve quality of life, as emphasized by the 2013 position statement of the World Heart Federation on the prevention and control of rheumatic heart disease 1.
From the Research
Definition of Cardiac Rheumatic
- Cardiac rheumatic refers to the heart-related complications that can arise from rheumatic fever, an autoimmune condition caused by infection with group A streptococcus 2, 3, 4, 5, 6.
- Rheumatic fever can lead to rheumatic heart disease (RHD), a condition characterized by damage to the heart valves, which can result in significant morbidity and mortality 2, 3, 4, 5, 6.
Causes and Risk Factors
- The primary cause of cardiac rheumatic disease is rheumatic fever, which is triggered by an infection with group A streptococcus 2, 3, 4, 5, 6.
- Risk factors for developing rheumatic fever and subsequent RHD include poor access to healthcare, inadequate treatment of streptococcal infections, and socioeconomic disadvantage 2, 3, 4, 5, 6.
Management and Prevention
- Secondary antibiotic prophylaxis, typically with intramuscular benzathine penicillin, is a cornerstone of RHD management and can help prevent recurrent episodes of rheumatic fever and further heart damage 2, 3, 4, 5, 6.
- Oral antibiotics may be considered as an alternative to intramuscular penicillin, particularly for patients with elevated risk of adverse reactions 5, 6.
- Education, register/recall systems, and dedicated health teams can also play a crucial role in enhancing the delivery of secondary antibiotic prophylaxis and reducing the burden of RHD 2.