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Rheumatic heart disease: current status of diagnosis and therapy
Ferande Peters1, Ganesan Karthikeyan2, Jessica Abrams3
1Cardiovascular pathophysiology and Genomic Unit, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Rheumatic heart disease (RHD) is a preventable cardiovascular condition. Updated diagnostic criteria and improved management strategies are crucial for reducing RHD
Area of Science:
- Cardiovascular Medicine
- Public Health
- Rheumatology
Background:
- Rheumatic heart disease (RHD) is the sole preventable cardiovascular disease, causing significant mortality and morbidity, especially in low- and middle-income countries.
- Early diagnosis of RHD is critical for effective management and prevention of long-term complications.
Purpose of the Study:
- To review recent epidemiological findings on RHD.
- To focus on diagnostic advancements and interventional strategies for rheumatic heart valve disease (RHVD).
- To discuss improvements in medical and surgical management of RHD.
Main Methods:
- Utilized updated Jones criteria for RHD diagnosis, incorporating echocardiographic findings of sub-clinical carditis and modified minor criteria.
- Reviewed clinical and echocardiographic investigations for rheumatic heart valve disease.
- Examined current medical, interventional, and surgical treatment approaches for severe RHD.
Main Results:
- The updated Jones criteria enhance diagnostic accuracy in endemic RHD settings.
- Echocardiography plays a vital role in diagnosing sub-clinical carditis and specific valve lesions.
- Current management involves a combination of medical, interventional, and surgical treatments for severe cases.
Conclusions:
- Renewed global efforts are essential to prioritize RHD, particularly in endemic regions.
- Strengthening diagnostic capabilities and management strategies can significantly reduce RHD burden.
- The 2018 World Heart Organization Resolution underscores the need for sustained action against Rheumatic Fever and Rheumatic Heart Disease.
Abstract:
Rheumatic heart disease (RHD) is the only preventable cardiovascular disease which causes significant morbidity and mortality particularly in low- and middle-income countries. Early clinical diagnosis is key, the updated Jones criteria increases the likelihood of diagnosis in endemic settings, including the echo diagnosis of sub-clinical carditis, polyarthralgia and monoarthritis as well as amended thresholds of minor criteria. The mainstay of rheumatic heart valve disease (RHVD) is a thorough clinical and echocardiographic investigation while severe disease is managed with medical, interventional and surgical treatment. In this report we detail some of the more recent epidemiological findings and focus on the diagnostic and interventional elements of the specific valve lesions. Finally, we discuss some of the recent efforts to improve medical and surgical management for this disease. As we are already more than a year from the historic 2018 World Heart Organization Resolution against Rheumatic Fever and Rheumatic Heart Disease, we advocate strongly for renewed efforts to prioritize this disease across the endemic regions of the world.
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