Rheumatic Fever and Valvular Heart Disease

  • Edmund A. W. Brice
  • Patrick J. Commerford


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.


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  1. 1.
    McLaren MJ, Hawkins DM, Koornhof HJ, et al. Epidemiology of rheumatic heart disease in black schoolchildren of Soweto, Johannesburg. Br Med J 1975;3:474–478.PubMedCrossRefGoogle Scholar
  2. 2.
    Siegel AC, Johnson EE, Stablemen GH. Controlled studies of streptococcal pharyngitis in a pediatric population. 1. Factors related to the attack rate of rheumatic fever. N Engl J Med 1961;265:559–565.CrossRefGoogle Scholar
  3. 3.
    Dale JB, Beachey EH. Sequence of myosin cross-reactive epitopes of streptococcal M protein. J Exp Med 1986;164:1785–1790.PubMedCrossRefGoogle Scholar
  4. 4.
    Haffejee I. Rheumatic fever and rheumatic heart disease: the current state of its immunology, diagnostic criteria and prophylaxis. Q J Med 1992;84:641–658.PubMedGoogle Scholar
  5. 5.
    Jones TD. Diagnosis of rheumatic fever. JAMA 1944;126:481–484.Google Scholar
  6. 6.
    Dajani AS, Ayoub EM, Bierman FZ, et al. Guidelines for the diagnosis of rheumatic fever: Jones criteria, updated 1992. JAMA 1992;268:2069–2073.CrossRefGoogle Scholar
  7. 7.
    Vasan RS, Shrivastava S, Vijayakumar M, et al. Echocardiographic evaluation of patients with acute rheumatic fever and rheumatic carditis. Circulation 1996;94:73–82.PubMedGoogle Scholar
  8. 8.
    Dajani AS. Current status of nonsuppurative complications of Group A streptococci. Pediatr Infect Dis J 1991;10:S25–S27.PubMedCrossRefGoogle Scholar
  9. 9.
    Albert DA, Harel L, Karrison T. The treatment of rheumatic carditis: a review and meta-analysis. Medicine (Baltimore) 1995;74:1–12.CrossRefGoogle Scholar
  10. 10.
    Lewis BS, Geft IL, Milo S, Gotsman MS. Echocardiography and valve replacement in the critically ill patient with acute rheumatic carditis. Ann Thorac Surg 1979;27:529–535.PubMedCrossRefGoogle Scholar
  11. 11.
    Lue HC, Wu MH, Wang JK, et al. Long-term outcome of patients with rheumatic fever receiving benzathine penicillin G prophylaxis every three weeks versus every four weeks. J Pediatr 1994;125:812–816.PubMedCrossRefGoogle Scholar
  12. 12.
    Hu MC, Walls MA, Stroop SD, et al. Immunogenicity of a 26-valent Group A Streptococcal vaccine. Infect Immun 2002;70:2171–2177.PubMedCrossRefGoogle Scholar
  13. 13.
    Olson LJ, Subramanian R, Ackermann DM, et al. Surgical pathology of the mitral valve. A study of 712 cases spanning 21 years. Mayo Clin Proc 1987;62:22–34.PubMedGoogle Scholar
  14. 14.
    Leavitt JI, Coats MH, Falk RH. Effects of exercise on transmitral gradient and pulmonary artery pressure in patients with mitral stenosis or a prosthetic mitral valve. A Doppler echocardiographic study. J Am Coll Cardiol 1991;17:1520–1526.PubMedGoogle Scholar
  15. 15.
    Ohmichi M, Tagaki S, Nomura N, et al. Endobronchial changes in chronic pulmonary venous hypertension. Chest 1988;94:1127–1132.PubMedGoogle Scholar
  16. 16.
    Barrington W W, Boudoulas J, Bashore T, et al. Mitral stenosis: Mitral dome excursion at M1 and the mitral opening snap3-the concept of reciprocal heart sounds. Am Heart J 1998;115:1280–1290.CrossRefGoogle Scholar
  17. 17.
    Klein HO, Sareli P, Schamroth CL, et al. Effects of atenolol on exercise capacity in patients with mitral stenosis with sinus rhythm. Am J Cardiol 1985;56:598–601.PubMedCrossRefGoogle Scholar
  18. 18.
    Marcus RH, Sareli P, Pocock WA, Barlow JB. The spectrum of severe rheumatic mitral valve disease in a developing country: correlations among clinical presentations, surgical pathologic finding and haemodynamic sequelae. Ann Intern Med 1994;120:177–183.PubMedGoogle Scholar
  19. 19.
    Carabello BA, Crawford FA. Valvular heart disease. N Engl J Med 1997;337:32–41.PubMedCrossRefGoogle Scholar
  20. 20.
    Rahimtoola SH. Valvular heart disease: a perspective. J Am Coll Cardiol 1983;1:199–215.PubMedCrossRefGoogle Scholar
  21. 21.
    Passik CS, Ackermann DM, Pluth JR, Edwards WP. Temporal changes in the causes of aortic stenosis: a surgical pathologic study of 646 cases. Mayo Clin Proc 1987;62:119–123.PubMedGoogle Scholar
  22. 22.
    Zitnik RS, Piemme TE, Messer RJ, et al. The masking of aortic stenosis by mitral stenosis. Am Heart J 1965;69:22–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Ross J Jr, Braunwald E. Aortic stenosis. Circulation 1968;38(Suppl V):V-61–V-67.Google Scholar
  24. 24.
    Scognamiglio R, Rahimtoola SH, Fasoli G, et al. Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med 1994;331:689–694.PubMedCrossRefGoogle Scholar
  25. 25.
    Rahimtoola SH. Indications for surgery in aortic valve disease. In: Yusuf S, Cairns JA, Camm AJ, eds. Evidence Based Cardiology. BMJ Books, London, 1998, pp. 811–832.Google Scholar
  26. 26.
    Braunwald E. Valvular heart disease. In: Braunwald EB, ed. Heart Disease: a Textbook of Cardiovascular Medicine, 5th ed. W. B. Saunders, Philadelphia, 1997, pp. 1007–1076.Google Scholar
  27. 27.
    Levinson GE. Aortic stenosis. In: Dalen JE, Alpert JS, eds. Valvular Heart Disease, 2nd ed. Little, Brown, Boston, 1987, pp. 202–203.Google Scholar

Recommended Reading

  1. 1.
    Bonow RO, Carabello B, de Leon AC Jr, et al. ACC/AHA guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol 1998;32:1486–1588.CrossRefGoogle Scholar
  2. 2.
    Carabello BA. Mitral valve disease: indications for surgery. In: Yusuf S, Cairns JA, Camm AJ, eds. Evidence Based Cardiology. BMJ Books, London, 2003, pp. 758–766.Google Scholar
  3. 3.
    Dajani A, Taubert K, Ferrieri P, et al. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Paediatrics 1995;96:758–764.Google Scholar
  4. 4.
    Otto CM, Burwask IG, Legget ME, et al. Prospective study of asymptomatic valvular aortic stenosis. clinical, echocardiographic, and exercise predictors of outcome. Circulation 1997;95:2262–2270.PubMedGoogle Scholar
  5. 5.
    Turi ZG. Balloon valvuloplasty: mitral valve. In: Yusuf S, Cairns JA, Camm AJ, eds. Evidence Based Cardiology. BMJ Books, London, 2003, pp. 796–808.Google Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Edmund A. W. Brice
    • 1
    • 2
  • Patrick J. Commerford
    • 3
    • 4
  1. 1.Department of MedicineUniversity of StellenboschSouth Africa
  2. 2.Tygerberg Academic HospitalCape TownSouth Africa
  3. 3.the Division of CardiologyUniversity of Cape TownSouth Africa
  4. 4.New Groote Schuur HospitalCape TownSouth Africa

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