Case Studies

 Case 2.6 Rheumatic heart disease

A 38-year-old labourer presented with a 3-month history of progressive shortness of breath on effort. Exertion was often associated with central chest pain and irregular palpitations. He had twice woken from sleep with attacks of frightening breathlessness and was unable to lie flat. His general health was good, with no weight loss or anorexia. He had been told that he had suffered from rheumatic fever when he was 9 years old.

On examination, he had the typical physical signs of congestive cardiac failure due to underlying mitral valve stenosis and rheumatic heart disease. There was no evidence of bacterial endocarditis. On treatment with digoxin, diuretics and anticoagulants, his exercise tolerance improved dramatically and cardiac surgery was postponed. Antibiotic cover was provided for any dental or surgical treatment, in order to prevent the development of subacute bacterial endocarditis.