Rheumatic Heart Disease

Introduction

Rheumatic fever results from an autoimmune response to a streptococcal throat infection and may lead to rheumatic heart disease. Cumulative exposure may propel clinically silent valvular disease to severe valvular damage and heart failure.

Rheumatic heart disease ranks among the most common non-communicable diseases in low and middle income countries, and accounts for up to a quarter of a million premature deaths every year. Acute rheumatic fever and rheumatic heart disease are physical manifestations of poverty and social inequality. Although largely eliminated in wealthy countries, three in four children aged 15 or younger grow up in parts of the world where rheumatic heart disease is still endemic. Rheumatic heart disease accounts for the greatest cardiovascular related loss of disability-adjusted life years among 10 to 14 year old children and continues to represent a major public health challenge in emerging countries.

Acute rheumatic fever is caused by an abnormal autoimmune response to group A streptococcal pharyngitis, which may manifest as arthritis of the large joints, affect the skin, the brain, and cause cardiac inflammation involving the valvular apparatus. Recurrent bouts of oligosymptomatic rheumatic fever may insidiously propel clinically silent valvular disease through different morphological and functional stages to severe valvular damage and heart failure. Secondary antibiotic prophylaxis constitutes the most effective therapeutic strategy for acute rheumatifc fever and rheumatic heart disease in low and middle income countries and will likely remain so until underlying risk factors – such as overcrowding, poor hygiene and limited access to healthcare – are transformed by socioeconomic change.