ABSTRACT
INTRODUCTION Rheumatic heart disease is the most serious manifestation of acute rheumatic fever and is the end result of carditis, which affects 30% to 45% of patients with acute rheumatic fever. Damage to the cardiac valves, which is the hallmark of rheumatic heart disease, may be chronic and progressive and, in conjunction with left ventricular dysfunction, can lead to congestive heart failure and death. Although both acute rheumatic fever and rheumatic heart disease are rare in more affluent populations in North America and Europe, where valvular disease is now largely degenerative, pockets of resurgence have occurred in these regions in recent years. Acute rheumatic fever continues essentially unchecked in many developing countries, where it is an important public health problem.
