Chronic rheumatic heart disease: occurrence and valve involvement
THE CONTEXT
Chronic rheumatic heart disease produces lasting valvular disease after rheumatic fever, although the preceding illness may have gone unrecognised.
Occurrence and clinical history
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Chronic valvular heart disease develops in at least half of patients who have rheumatic fever with carditis.
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Women account for two-thirds of cases.
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A history of rheumatic fever or chorea can be elicited in only about half of patients with chronic rheumatic heart disease because some episodes pass unrecognised.
Distribution of valve lesions
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The mitral valve is affected in more than 90% of cases.
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After the mitral valve, the order of involvement is aortic, tricuspid and then pulmonary.
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Isolated mitral stenosis accounts for about 25% of cases; an additional 40% have mixed mitral stenosis and regurgitation.