Rheumatic heart disease is caused by rheumatic fever, which is a sequela of strep throat infections. It is a major cause of mitral valve insufficiency and stenosis globally, with 15 million cases worldwide and over 200,000 deaths in 2008. In India, it commonly affects children aged 5-15, with a prevalence of 5-7 cases per 1,000 children. The severity of valve damage depends on factors like the number of previous rheumatic fever attacks, time between onset and treatment, and sex. Prevention involves treating strep throat infections aggressively with benzathine penicillin injections over multiple years.

1. RHEUMATIC HEART DISEASE
Dr Ubaid N P
Community Medicine
Pariyaram Medical College

2. Introduction
• Rheumatic fever –febrile disease affecting connective
tissues, esp. heart and joints
• Sequele to throat infection by group A beta haemolytic
streptococci
• RF is not a communicable disease – results from a
communicable disease
• RF often leads to Rheumatic Heart Disease (RHD)

3. Problem statement
• 15 million cases of RHD worldwide
• 220000 deaths due to RHD in 2008
• Major cause of mitral insufficiency and stenosis
• In India prevalence more common on 5 – 15 age
group (5-7/ thousand children)
• RF is said to occur in 1-3% of all streptococcal
infections in children

4. • Severity of valve disease is directly related to:
- no of previous attacks of RF
- Length of time between onset of disease &
start of therapy
- Sex (F > M)

5. Agent
• Group A beta Haemolytic Streptococcus
• Onset of RF is preceded by a streptococcal sore
throat
• High carrier rate – convalescent, transcient and
chronic carriers

6. Host & Environment Factors
• Typically a childhood and adolescent disease (5 – 15
years)
• High incidence of ‘Juvenile mitral stenosis in India’
• Prevalence in M = F, but prognosis is more worse in
Female
• Disease is related to low standard of living
• High risk groups – school age children, slum dwellers,
those living in closed community (e.g: barracks)

7. Clinical features
• Fever – acute, may last 12 weeks or longer, recurs
• Polyarthritis – occurs in 90% cases, Large joints affected more
commonly
• Carditis – valves and all layers involved, manifested by tachycardia,
murmers, enlargement, pericarditis, heart failure, first degree AV
block in ECG
• Nodules – small, painless nodules below skin
• Brain involvement – abnormal jerky movements of arms, legs and the
body
• Skin involvement - various skin rashes

10. Diagnosis

11. Diagnosis

12. Prevention
a) Primary prevention
b) Secondary prevention:
- one i/m injection of benzathine pencillin (1.2 million
in adults & 600,000 units in children)
- given at an interval of 3 weeks, for at least 5 years
or till the age of 18 years(which ever later)
- severe valvular disease and post valve surgery
cases need life long treatment
a) Non medical measures