Natural history, screening, and management of rheumatic heart disease
- Bongani Mayosi, MBChB, PhD, FCP(SA)
Bongani Mayosi, MBChB, PhD, FCP(SA)
- Professor and Head of Department of Medicine: Faculty of Health Science
- University of Cape Town
Rheumatic heart disease (RHD) remains a major cause of cardiovascular disease in developing nations, although the prevalence of RHD has declined sharply in industrialized countries during the last century .
This topic will review the epidemiology, natural history, screening, and management of RHD. The epidemiology, pathogenesis, diagnosis, treatment, and prevention of acute rheumatic fever are discussed separately. (See "Acute rheumatic fever: Epidemiology and pathogenesis" and "Acute rheumatic fever: Clinical manifestations and diagnosis" and "Acute rheumatic fever: Treatment and prevention".)
Rheumatic heart disease (RHD) is by far the most important form of acquired heart disease in children and young adults living in developing countries (which are inhabited by 80 percent of the world’s population); RHD accounts for about 15 percent of all patients with heart failure in endemic countries [2,3].
RHD is a disease of poverty . The impact of socioeconomic status is illustrated by a study from Kinshasa where the prevalence based on clinical examination was 22.2 per 1000 among children who lived in slums but only 4 per 1000 among children attending the city schools . The importance of socioeconomic factors is further underscored by the virtual disappearance of RHD in the industrialized countries since the mid-20th century, which started well before the introduction of penicillin. In contrast, RHD is still endemic in Africa, Asia, South America, and developing communities of Australasia [6-8].
Echocardiographic diagnostic criteria have revealed high prevalence rates in developing countries; for example, 21.5 per 1000 in Cambodia, 30.4 per 1000 in Mozambique, 48 per 1000 in Nicaragua, and 62 per 1000 in Kenya, providing an average point prevalence of 40 per 1000 in school-aged children [6,7,9]. The prevalence of RHD is 20 per 1000 among young adults (20 to 35 years) in Nicaragua . Based on these data, it is estimated that there are 62 to 78 million individuals who have RHD worldwide, a disease burden that could potentially result in 1.4 million deaths per year from RHD and its complications .
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- NATURAL HISTORY
- Acute rheumatic fever
- Transition from acute to chronic disease
- Chronic valve disease
- - Stages of disease and relationship to age
- - Mitral stenosis
- - Mitral regurgitation
- - Mixed mitral stenosis/regurgitation
- - Aortic regurgitation
- - Aortic stenosis
- - Tricuspid valve disease
- SCREENING IN ENDEMIC SETTINGS
- Types of screening
- Screening summary
- Minimizing disease progression
- Valve disease
- - Management of mitral regurgitation
- - Management of mitral stenosis
- Atrial fibrillation
- Thromboembolism prevention
- - Management of mixed mitral disease
- - Management of aortic regurgitation
- - Management of aortic stenosis
- - Management of mixed aortic valve disease
- - Management of tricuspid valve disease
- - Pregnancy
- HEALTH MAINTENANCE
- SUMMARY AND RECOMMENDATIONS