In this episode, we review rheumatic heart disease, a chronic valvular complication that develops after acute rheumatic fever following untreated Group A Streptococcal pharyngitis. We discuss the autoimmune pathophysiology driven by molecular mimicry, leading to inflammatory damage of the heart valves, particularly the mitral valve. Clinical manifestations including migratory polyarthritis, carditis, murmurs, Sydenham chorea, erythema marginatum, and subcutaneous nodules are reviewed along with the classic Jones criteria used for diagnosis. We also cover characteristic echocardiographic findings, long-term complications such as mitral stenosis, atrial fibrillation, heart failure, and embolic stroke, and treatment strategies including antibiotics, anti-inflammatory therapy, and secondary prophylaxis with penicillin.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nature Reviews Disease Primers. 2016;2(1). doi:10.1038/nrdp.2015.84
3. Dougherty S, Okello E, Mwangi J, Kumar RK. Rheumatic heart disease. Journal of the American College of Cardiology. 2023;81(1):81-94. doi:10.1016/j.jacc.2022.09.050
4. Marijon E, Mirabel M, Celermajer DS, Jouven X. Rheumatic heart disease. The Lancet. 2012;379(9819):953-964. doi:10.1016/s0140-6736(11)61171-9