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.

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.

Clinical toolsCalculators

BMI GCS EDD Parkland Formula

Corrected Sodium Corrected Calcium Anion Gap Creatinine Clearance Insulin Calculations qSOFA Wells PE Wells DVT CHA₂DS₂-VASc HAS-BLED CURB-65 Centor/McIsaac

Paediatric Heart Failure

Heart failure in children is a clinical syndrome in which cardiac output is inadequate for metabolic requirements or can only be maintained at abnormally elevated filling pressures.

Causes vary with age and include congenital heart disease, cardiomyopathy, myocarditis, arrhythmia and severe anaemia.

Treat the underlying cardiac lesion.

For congestion:

Furosemide 1 mg/kg IV or PO per dose, repeated according to clinical response.

Fluid and sodium management depends on severity.

ACE inhibitors are useful in selected systolic dysfunction and significant left to right shunts.

Children with shock require intensive care, careful haemodynamic assessment and selected inotropic support rather than indiscriminate fluid boluses.

Rheumatic Heart Disease In Children

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management