Overview
Chronic rheumatic carditis, also known as rheumatic heart disease (RHD), is a chronic sequela of acute rheumatic fever and remains the most common cardiovascular disease in children and young people globally 1. It affects over 40.5 million people worldwide, leading to significant mortality 2.Diagnosis
Echocardiography is the most important diagnostic tool for RHD 1.
Diagnostic findings include commissural fusion, leaflet thickening, restricted leaflet mobility, and varying degrees of calcification, predominantly affecting the mitral valve 1.
Severity of valvular lesions and hemodynamic effects on cardiac chambers and pulmonary artery pressures should be assessed 1.
Echocardiographic screening can detect RHD at an early, latent stage 2.Management
Echocardiographic guidance is critical during catheter-based or surgical treatment of RHD 1.
Echocardiographic surveillance is recommended post-intervention 1.
Secondary antibiotic prophylaxis with penicillin G benzathine injections every 4 weeks for 2 years was studied in Ugandan children with latent RHD 2.Special Populations
RHD is the most common cardiovascular disease in children and young people worldwide 1.Key Recommendations
Echocardiography is the most important diagnostic tool in recognizing RHD and plays an invaluable role in detecting subclinical disease 1. (Evidence: Expert opinion)
Echocardiographic diagnosis of RHD is made when typical findings of valvular and subvalvular abnormalities are seen 1. (Evidence: Expert opinion)
The severity of valvular lesions and hemodynamic effects on the cardiac chambers and pulmonary artery pressures should be rigorously examined using echocardiography 1. (Evidence: Expert opinion)
Secondary antibiotic prophylaxis with penicillin G benzathine injections every 4 weeks for 2 years may be considered for latent RHD 2. (Evidence: Moderate)References
1 Pandian NG, Kim JK, Arias-Godinez JA, Marx GR, Michelena HI, Chander Mohan J et al.. Recommendations for the Use of Echocardiography in the Evaluation of Rheumatic Heart Disease: A Report from the American Society of Echocardiography. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2023. link
2 Beaton A, Okello E, Rwebembera J, Grobler A, Engelman D, Alepere J et al.. Secondary Antibiotic Prophylaxis for Latent Rheumatic Heart Disease. The New England journal of medicine 2022. link