Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies

Carditis is the hallmark of acute rheumatic fever, characterized by inflammation of the heart's endocardium, myocardium, and pericardium. Patients develop new heart murmurs, chest pain, palpitations, and dyspnea. These acute symptoms result from valvular damage and can progress to chronic disease if untreated or inadequately managed.

Mitral stenosis or regurgitation causes increased left atrial pressure, leading to left atrial enlargement. This enlargement disrupts normal electrical conduction, triggering atrial fibrillation. The arrhythmia increases stroke risk through thromboembolism, making it a serious complication of chronic RHD requiring careful monitoring and intervention.

Echocardiography is the primary imaging tool for RHD diagnosis. Transthoracic echocardiography provides detailed heart images, detecting valvular lesions like mitral stenosis or regurgitation, assessing left atrial size and ventricular function, and identifying vegetations or thrombi. Transesophageal echocardiography offers enhanced detail when more precise valve assessment is needed.

Blood tests including antistreptolysin O titer, C-reactive protein, and erythrocyte sedimentation rate support RHD diagnosis. Elevated ASO titers indicate recent streptococcal infection, while increased CRP and ESR levels demonstrate inflammatory response, confirming rheumatic fever as the underlying cause of valvular disease.

Chronic RHD stems from repeated carditis episodes, causing progressive valvular damage. Patients experience persistent heart murmurs, atrial fibrillation, and chronic heart failure symptoms including fatigue, dyspnea, peripheral edema, and orthopnea. Severe valvular disease significantly impairs cardiac function and quality of life.

Electrocardiography detects arrhythmias such as atrial fibrillation and prolonged PR intervals indicating delayed atrioventricular conduction. Chest X-ray reveals cardiomegaly and pulmonary congestion associated with severe valvular disease. Together, these diagnostic tests provide complementary information about cardiac structure and electrical function.

Doppler ultrasound assesses the severity of valvular stenosis or regurgitation by measuring blood flow velocity across the affected valves. Performed alongside echocardiography, it quantifies hemodynamic changes and helps clinicians determine disease progression and treatment urgency in RHD patients with significant valvular involvement.