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Rheumatic heart disease

Dr Bo Remenyi and Dr Jonathan Carapetis performing echocardiography used in the management of RHD in Fiji
Dr Rosemary Wyber / RhEACH

Rheumatic heart disease

Diagnosis

Diagnosis of RHD is classically based on clinical history and examination. Echocardiographic findings of rheumatic heart valve damage can confirm the diagnosis. ECG and chest x-ray changes may provide supportive evidence in settings where echocardiography is unavailable.

Interactive Australian modules on the diagnosis and management of RHD are available online.

Management

In addition to secondary prophylaxis, medical management of the consequences of RHD is often needed. The first presentation of RHD is generally heart failure. In an Australian population 27% of people developed heart failure within 5 years of RHD diagnosis. In many settings, RHD patients present even later in the course of their disease - 46% of first presentations were in class NYHA III/IV heart failure in Uganda,344,18% in Soweto, South Africa.163  Medical management of RHD involves using medications to control symptoms, improve outcomes and reduce complications.

Detailed guidelines for the medical and surgical management of valvular heart disease have been developed in Europe and in the United States of America. However, resources to deliver cardiac investigations, therapy and surgery are limited in countries with the greatest burden of RHD. Guidelines from high resource settings where RHD is relatively rare do not necessarily account for clinical and technical complexities in resource limited settings.

United States of America

Europe

Canada

Specific challenges in medical and surgical care for RHD are addressed in publications listed below and reflected in following guidelines.

Australia

India

New Zealand

An interactive Australian module on the medical management of mitral valve disease is available online.

Information on different models of providing tertiary care, access to surgery, capacity building and health systems strengthening can be found in the control section of this site.