Essential Cardiology

pp 545-563

Rheumatic Fever and Valvular Heart Disease

  • Edmund A. W. BriceAffiliated withDepartment of Medicine, University of StellenboschTygerberg Academic Hospital
  • , Patrick J. CommerfordAffiliated withthe Division of Cardiology, University of Cape TownNew Groote Schuur Hospital

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Rheumatic fever causes most cases of acquired heart disease in children and young adults worldwide. It is generally classified as a collagen vascular disease where the inflammatory insult is directed mainly against the tissues of the heart, joints, and the central nervous system. The inflammatory response, which is characterized by fibrinoid degeneration of collagen fibrils and connective tissue ground substance, is triggered by a throat infection with Group A β-hemolytic streptococci (GAS). The destructive effects on cardiac valve tissue accounts for most of the morbidity and mortality seen in the disease through the serious hemodynamic disturbances produced.