Rheumatic Heart Disease:
Pathogenesis, Diagnosis, and
Global Strategies
• Presented by [Your Name]
• Institution/Organization (if applicable)
• Date: February 25, 2025
• Subtitle: A Journey from Streptococcus to
Valvular Damage
Understanding Rheumatic Heart
Disease
• • RHD is a chronic condition caused by
repeated or severe Acute Rheumatic Fever
(ARF).
• • Autoimmune-mediated valvular
inflammation leads to fibrosis and progressive
damage.
• • **Epidemiology:**
• - Affects over 40 million people globally.
• - Highest prevalence in low-income and
developing countries.
Pathogenesis of Acute Rheumatic
Fever
• • Streptococcal pharyngitis (GAS infection)
triggers an autoimmune response.
• • Molecular mimicry leads to cross-reactivity
between bacterial M-proteins and cardiac
tissues.
• • Immune-mediated damage causes
inflammation in heart valves, joints, brain, and
skin.
Jones Criteria for Diagnosing ARF
• Jones Criteria (2015) is used to diagnose Acute
Rheumatic Fever.
Treatment Phase Strategy Example Medications
Acute Antibiotics Benzathine Penicillin G
• AAcute
patient must meet **2 major**
Anti-inflammatory Aspirin,or **1
Corticosteroids
major
Chronic + 2 minorSecondary
criteria** withIM
Prophylaxis evidence of
Penicillin every 3-4
weeks
recent GAS infection.
Severe Cases Surgical Valve
Replacement
Mechanical/
Bioprosthetic Valve
Clinical Features of RHD
• Symptoms:
• • Dyspnea, fatigue, chest pain, palpitations.
• • Symptoms vary based on severity and
valvular involvement.
• Signs:
• • Murmurs: Mitral stenosis (diastolic rumble),
Mitral regurgitation (holosystolic murmur).
• • Arrhythmias, heart failure signs (peripheral
Global Prevalence of RHD
• • Highest burden in sub-Saharan Africa, South
Asia, and the Pacific Islands.
• • Declining rates in developed
Prevalence (%) nations due to
antibiotic
8 use and improved healthcare access.
6
4
2
0
Africa Asia Pacific Europe Americas
Complications of RHD
• • **Progressive Valvular Dysfunction:**
• - Mitral stenosis → Left atrial enlargement →
Pulmonary hypertension.
• - Aortic regurgitation → Volume overload →
Heart failure.
• • **Arrhythmias:**
• - Atrial fibrillation (due to left atrial dilation).
• • **Thromboembolism & Stroke:**
• - Stagnant blood in atria increases clot risk.
Management Strategies for ARF &
RHD
• • **Acute Phase:**
• - **Antibiotics:** IM benzathine penicillin G
for GAS eradication.
Treatment Phase Strategy Example Medications
Acute Antibiotics Benzathine Penicillin G
• Acute
- **Anti-inflammatory therapy:**
Anti-inflammatory Aspirin or
Aspirin, Corticosteroids
corticosteroids.
Chronic Secondary Prophylaxis IM Penicillin every 3-4
weeks
• Severe
- **Supportive
Cases
care:**
Surgical Valve
Replacement Bed rest, heartValve
Mechanical/
Bioprosthetic failure
management.
• • **Long-term Management:**
Surgical and Interventional
Treatment
• Indications:
• • Severe valvular stenosis or regurgitation
with symptomaticPrevalence
heart failure.
(%)
8
6
• Surgical
4 Options:
• •2Valve repair (commissurotomy for mitral
stenosis).
0
Africa Asia Pacific Europe Americas
• • Valve replacement (mechanical or
bioprosthetic).
Global Efforts to Combat RHD
• • WHO and international health organizations
promote RHD control programs.
• • Early detection Prevalence
programs (%)and school-based
screenings
8 in high-burden areas.
6
4
2
0
Africa Asia Pacific Europe Americas
Conclusion & Key Takeaways
• 1. **RHD is preventable** but remains a
global challenge.
• 2. **Early antibiotic treatment and
prophylaxis are essential.**
• 3. **Echocardiography remains the gold
standard for diagnosis.**
• 4. **Surgical interventions improve
outcomes** but require better accessibility.
• 5. **Public health initiatives and research are
critical to RHD eradication.**