Musings of a Cardiologist

The ACC/AHA/ESC, in its latest guidelines on the management of heart failure with reduced ejection fraction (HFrEF), highlights the importance of quadruple drug therapy for effective heart failure management. This comprehensive approach involves the use of a beta blocker, mineralocorticoid receptor antagonist, SGLT2 inhibitor, and RAS antagonist or ARNI. Notably, a similar combination therapy is available for patients with rheumatic heart disease, emphasizing the need for tailored treatment strategies for specific cardiac conditions.

Rheumatic heart disease (RHD) holds significant relevance in developing countries like India, where its impact cannot be understated. The incidence of Acute Rheumatic Fever (ARF) is approximately 8-7 persons per 100,000 among 5 to 14-year-olds, further emphasizing the need for proactive management and early diagnosis. Additionally, the prevalence of RHD in India is estimated to be around 0.5 – 1 person per 1000, shedding light on the substantial burden of this condition within the population. Early diagnosis and effective management play a pivotal role in preventing the long-term complications associated with RHD, such as cerebrovascular accidents and valvular cardiomyopathy.

In the context of established rheumatic valvular heart disease, medical therapy aims to alleviate symptoms and enhance overall quality of life. The pillars of medical therapy for RHD encompass various interventions, including beta blockers for rate control, diuretics to reduce preload and relieve congestion, oral anticoagulants for preventing cerebral thromboembolism, and penicillin therapy for the prevention of recurrent carditis.

This comprehensive approach to medical management can be likened to the “four-pillar therapy” for established rheumatic heart disease, highlighting the multifaceted nature of treatment for this complex cardiac condition. By acknowledging the specific nuances of RHD and tailoring therapeutic strategies accordingly, healthcare professionals can strive to enhance patient outcomes and mitigate the long-term impact of this disease.