Rheumatic Heart Disease In Children

Rheumatic heart disease is permanent valvular damage following acute rheumatic fever.

It remains an important cause of acquired cardiac disease among children and young adults in many low and middle income settings, including sub Saharan Africa.

The mitral valve is most frequently affected.

Children may be asymptomatic initially.

Progressive disease may cause:

• Exertional dyspnoea
• Fatigue
• Palpitations
• Orthopnoea
• Heart failure
• Murmur of mitral regurgitation or stenosis

Echocardiography defines:

• Valve morphology
• Regurgitation or stenosis severity
• Ventricular function
• Pulmonary pressure

The most important preventive treatment is secondary antibiotic prophylaxis against recurrent acute rheumatic fever.

Benzathine benzylpenicillin IM every 3 to 4 weeks is standard, with dose determined by weight and local protocol.

Duration depends on the history of carditis and presence of residual valvular disease and may extend well into adulthood.

Treat heart failure, arrhythmias and anticoagulation indications according to the specific valve lesion.

Severe valve disease requires cardiology and cardiothoracic assessment for repair or replacement.