Rheumatic heart disease screening : current concepts and challenges

dc.contributor.authorDougherty, Scotten_ZA
dc.contributor.authorKhorsandi, Maziaren_ZA
dc.contributor.authorHerbst, Philipen_ZA
dc.identifier.citationDougherty, S., Khorsandi, M. Herbst, P. 2017. Rheumatic heart disease screening : current concepts and challenges. Annals of Pediatric Cardiology, 10(1):39-49, doi:10.4103/0974-2069.197051
dc.identifier.issn0974-5149 (online)
dc.identifier.issn0974-2069 (print)
dc.descriptionCITATION: Dougherty, S., Khorsandi, M. Herbst, P. 2017. Rheumatic heart disease screening : current concepts and challenges. Annals of Pediatric Cardiology, 10(1):39-49, doi:10.4103/0974-2069.197051.
dc.descriptionThe original publication is available at
dc.description.abstractRheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.en_ZA
dc.format.extent11 pages
dc.publisherMedknow Publications
dc.subjectRheumatic feveren_ZA
dc.subjectRheumatic heart diseaseen_ZA
dc.titleRheumatic heart disease screening : current concepts and challengesen_ZA
dc.description.versionPublisher's version
dc.rights.holderAnnals of Pediatric Cardiology

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