A valvular complication of rheumatic fever - see p18

The valves commonly involved are:

• Mitral valves leading to stenosis, incompetence or both
• Aortic valve leading to stenosis and incompetence

Cause

• As for acute rheumatic fever - see p18

Clinical features

• Dyspnoea

• Palpitations

• Heart murmurs depending on valves affected and nature of effect caused

• The patient may be asymptomatic and the valvular lesion discovered as an incidental finding

• Increased cardiac demand as in pregnancy and anaemia may lead to congestive cardiac failure as a presentation

Differential diagnosis

• Other causes of cardiac failure

Investigations

Chest X-ray
ECG where available
Echocardiography

Management

benzathine penicillin 2.4 MU IM once monthly

child:

benzathine penicillin <30kg: 0.6 MU once monthly >30kg: 1.2 MU once monthly

or phenoxymethylpenicillin 250mg every 12 hours

- continue either drug up to 18 years of age