scholarly journals Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 142 (20) ◽  
Author(s):  
Raman Krishna Kumar ◽  
Manuel J. Antunes ◽  
Andrea Beaton ◽  
Mariana Mirabel ◽  
Vuyisile T. Nkomo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Treatment Options ◽  
Heart Association ◽  
Population Based ◽  
Diagnosis And Treatment ◽  
Optimal Care ◽  
Percutaneous Balloon ◽  
Rheumatic Heart

The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.

scholarly journals Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253581
Author(s):  
Joshua Liaw ◽  
Betrice Walker ◽  
Leanne Hall ◽  
Susan Gorton ◽  
Andrew V. White ◽  
...  
Keyword(s):  
Heart Disease ◽  
Preterm Birth ◽  
Rheumatic Heart Disease ◽  
Perinatal Death ◽  
Meta Analysis ◽  
Heart Association ◽  
Fetal Outcomes ◽  
Percutaneous Balloon ◽  
Rheumatic Heart ◽  
In Pregnancy

Purpose Associations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy. Methods Medline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529). Findings The search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54–5.33), and perinatal death (6 studies, RR 3.23, 1.92–5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02–4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02–5.95). Interpretation RHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.

scholarly journals The American Heart Association’s Call to Action for Reducing the Global Burden of Rheumatic Heart Disease: A Policy Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 142 (20) ◽  
Author(s):  
Andrea Beaton ◽  
Flavia B. Kamalembo ◽  
James Dale ◽  
Joseph H. Kado ◽  
Ganesan Karthikeyan ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
World Health ◽  
Policy Statement ◽  
World Health Assembly Resolution ◽  
Worker Education ◽  
Rheumatic Heart

Rheumatic heart disease (RHD) affects ≈40 million people and claims nearly 300 000 lives each year. The historic passing of a World Health Assembly resolution on RHD in 2018 now mandates a coordinated global response. The American Heart Association is committed to serving as a global champion and leader in RHD care and prevention. Here, we pledge support in 5 key areas: (1) professional healthcare worker education and training, (2) technical support for the implementation of evidence-based strategies for rheumatic fever/RHD prevention, (3) access to essential medications and technologies, (4) research, and (5) advocacy to increase global awareness, resources, and capacity for RHD control. In bolstering the efforts of the American Heart Association to combat RHD, we hope to inspire others to collaborate, communicate, and contribute.

Underuse of Injectable Penicillin in Secondary Prophylaxis of Rheumatic Heart Disease in Nepal

2020 ◽  
Vol 01 (01) ◽  
pp. 009-012
Author(s):  
Laudari S
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Cross Sectional Study ◽  
Secondary Prophylaxis ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Rheumatic Heart

Background and Aims: Secondary prophylaxis has remained the mainstay of rheumatic fever and rheumatic heart disease management. Despite the proven ef􀏐icacy and superiority of injectable penicillin in rheumatic heart disease patients, it has been underused in Nepal. Materials and Methods: This is a hospital based cross-sectional study during June 2014 to October 2018 over a period of 52 months at College of Medical Sciences-Bharatpur including 350 patients with clinical and/or echocardiographic evidence of de􀏐inite rheumatic heart disease. Data was collected from both cardiology outpatients and inpatients (admitted in cardioward/coronary care unit). Relevant data and information were entered into the pre-structured proforma and then analyzed by SPSS-16 software. Results: The age of the patients ranged from 6 to 80 years with mean age 36.76±4.6years with female preponderance (F:M=1.26:1). The predominantly involved isolated valve was mitral in 152 patients (44.43%) followed by aortic valve in 70 patients (20.00%) and rest 90 (25.71%) had dual valvular involvement. The common complications encountered were heart failure in 200(57.14%) and arrhythmias in 155(44.29%) patients. Two hundred ten (60.00%) of the patients received penicillin (oral and injectable) and erythromycin. Majority 180/210=85.71%) were prescribed on oral penicillin whereas only 46/210=21.90% received injectable penicillin; the ratio being 3.35:1. Conclusion: RHD is a leading cause of heart failure and death among young population. There is underuse of penicillin with very minimal focus on use of injectable penicillins currently. Hence, Nepal government and other non-governmental organizations should consider implementation of use of penicillin broadly and moreover focus on use and adherence of injectable penicillin. Keywords: Rheumatic Heart Disease, Penicillin, Underuse, Secondary Prophylaxis.

scholarly journals Rheumatic heart disease burden, trends, and inequalities in the Americas, 1990–2017: a population-based study

2019 ◽  
Vol 7 (10) ◽  
pp. e1388-e1397 ◽  
Author(s):  
Pedro Ordunez ◽  
Ramon Martinez ◽  
Patricia Soliz ◽  
Gloria Giraldo ◽  
Oscar J Mujica ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Disease Burden ◽  
Population Based ◽  
Population Based Study ◽  
Rheumatic Heart

OC02_09 Next Generation Data Collection and Organizing System to Support Population-Based Screening for Rheumatic Heart Disease

Global Heart ◽  
2016 ◽  
Vol 11 (2) ◽  
pp. e3
Author(s):  
J. van Dam ◽  
J.C. Lungu ◽  
E. Machila ◽  
S. Schwaninger ◽  
M. Phiri ◽  
...  
Keyword(s):  
Heart Disease ◽  
Data Collection ◽  
Rheumatic Heart Disease ◽  
Population Based ◽  
Next Generation ◽  
Rheumatic Heart

scholarly journals To Study the Maternal and Neonatal Outcomes of Pregnancies complicated by Rheumatic Heart Disease

2014 ◽  
Vol 5 (3) ◽  
pp. 92-94
Author(s):  
Uma Pandey
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Nyha Class ◽  
Heart Association ◽  
Neonatal Outcomes ◽  
Fetal Mortality ◽  
Class Iii ◽  
Maternal And Neonatal Outcomes ◽  
Pregnant Mothers ◽  
Rheumatic Heart

ABSTRACT Objectives To study the maternal and neonatal outcomes of pregnancies complicated by rheumatic heart disease (RHD). Materials and methods A retrospective study was carried out in the obstetric and cardiology outpatients department of Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India over a period of 1 year (Dec 2011-2012) involving 96 pregnant patients with rheumatic heart disease. Their maternal and fetal outcomes were reviewed. Results A total of 96 pregnant mothers with heart disease presented to us during the period of 1 year (Dec 2011-2012). Majority of the pregnant mothers had mitral stenosis n = 46 (47%). Rest of the patients had multivalve disease. Pulmonary arterial hypertension was found to be in 28 patients (29%). Atrial thrombus was seen in the echocardiography of one patient. Mitral valve replacement was done before pregnancy in 16 mothers (16%); these gravid mothers were put on low-molecular weight hepanin (LMWH) and during the midtrimester on the Acitrom. There was one patient admitted with atrial fibrillation. New York Heart Association (NYHA) class I and II heart disease progressed in two patients to class III and IV. There was no maternal or fetal mortality in this study. There were 24 cesarean sections (25%) done out of which 8 were for intrauterine growth restriction (IUGR) (32%), rest were due to maternal reasons. There were 12 preterm deliveries. Four fetuses had intraventricular hemorrhage. Conclusion Despite no maternal and neonatal mortality, pregnancy in women with heart disease is associated with significant maternal and neonatal morbidities. How to cite this article Pandey U. To Study the Maternal and Neonatal Outcomes of Pregnancies complicated by Rheumatic Heart Disease. Int J Infertil Fetal Med 2014;5(3):92-94.

scholarly journals RIGHT SIDED ENDOCARDITIS: CASE SERIES FROM MOROCCO

2021 ◽  
Vol 9 (4) ◽  
pp. 704-714
Author(s):  
A. Laalou ◽  
◽  
A. Chachi ◽  
A. Benbahia ◽  
S. Jourani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Rheumatic Heart Disease ◽  
Pulmonary Valve ◽  
Indwelling Catheters ◽  
Cardiac Devices ◽  
Wide Range ◽  
Rheumatic Heart

Objective: Compared with the extensive data on left sided infective endocarditis, right-sided infective endocarditis (RSIE) remains a rare condition. It accounts for 5–10% of all cases of infective endocarditis (IE) [1] [2] [3].Although it is predominantly encountered in the injecting drug user (IDU) population, where HIV and HCV infections often coexist, rheumatic heart disease remains the most important predisposing factor for IE in our context. The aim our study is to report clinical, investigation, management and outcome data in 5 patients diagnosed with RSIE in our department during the last 2 years. Methods: A retrospective analysis of data of 5 patients with right sided endocarditis in a tertiary care center from 2018 to 2020 was done. Results: All of our patients were young aged females none of them had cardiac devices or history of drug use. Persistent fever was the most common clinical presentation. Interestingly, 4 patients presented clinical heart failure. 3 patients had isolated tricuspid valve IE, one patient had isolated pulmonary valve IE, and one patient have both tricuspid and pulmonary valve IE. Blood cultures were negative in two cases, whilst two others were positive to Streptococcus (alpha) and one positive to Staphylococcus. 4 patients underwent surgical treatment after well conducted antibiotic therapy the indications were the presence of right heart failure secondary to severe tricuspid regurgitation and the size of the vegetations. Unfortunately, one patient died of massive pulmonary embolism despite well conducted antibiotherapy. Conclusion: RSIE is rare and occurs in a wide range of underlying conditions like implantable electronic devices, indwelling catheters, CHD and immune compromised state. Surprisingly, it can occur in young individuals without known risk factors. In our context, rheumatic heart disease remains the most incriminated etiology which lead us to question three essential points: 1. The interest of antibiotic prophylaxis in young patients with VSDs 2. The use of empiric antibiotics with action against streptococcus 3. Early surgical treatment in rheumatic heart disease.

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