Introduction
Rheumatic heart disease is a complication of rheumatic fever – a common cause of cardiac failure in Nigeria.
In Africa, it manifests later compared to Caucasians.
The mitral valve is most affected, followed by the aortic, then the tricuspid.
The lesions can occur in various combinations of regurgitation and stenosis
Clinical features
- Exertional dyspnoea
- Paroxysmal nocturnal dyspnoea
- Orthopnoea
- Leg and abdominal swelling
- Cough with production of frothy sputum
- Pedal and sacral oedema
- Small volume pulse, which may be irregular
- With or without tachycardia
- With or without hypotension
- Raised JVP
- Displaced apex
- Left ventricular hypertrophy
- Right ventricular hypertrophy
- Thrills
- Palpable P2
- Soft S1; loud P2
- S3 or S4
- Systolic/diastolic murmurs
Differential diagnoses
- Constrictive pericarditis
- Endomyocardial fibrosis
- Dilated cardiomyopathy
Complications
- Arrhythmias e.g. atrial fibrillation, heart block
- Cardiac failure
- Embolic phenomena
- Endocarditis
Investigations
- Chest radiograph
- Electrocardiography
- Echocardiography
- Coronary angiography
- Electrolytes, Urea and Creatinine
Treatment objectives
- Relieve symptoms
- Prevent recurrence of rheumatic attack
- Repair and replace affected valves
Non-drug treatment
- Bed rest
- Low salt diet
Drug treatment
- Treat for heart failure if present
- Use anticoagulants if necessary
- Prophylaxis against endocarditis (see Infective Endocarditis).
- Benzathine penicillin 720 mg (1.2 million units) intra musculary monthly for life
Other measures:
- Valve replacement
- Valve repair
- Treat endocarditis
Notable adverse drug reactions, caution
- Penicillin may cause hypersensitivity reaction/ anaphylaxis
- Caution in patients with a history of
penicillin allergy
Prevention
Personal hygiene and good sanitation to
prevent recurrence of rheumatic fever