24 Are We Overlooking Rheumatic Heart Disease in the Conundrum of CAD–The Indian Scene

Abstract: Today the practice in cardiology has become synonymous with caring for patients of ischemic heart disease (IHD) right from diagnosis to interventions. This is because in the global scenario there is an increasing incidence of ischemic heart disease and a decreasing prevalence of rheumatic heart disease (RHD) so much so that the medical students in developed countries would not have ever seen a case of RHD in their whole career. In the developing countries like India the statistics for the incidence and prevalence of RHD are available since the past several decades but there is scant and unreliable statistics for IHD. Whereas, it is just the opposite in the developed countries where detailed data are available for IHD and its risk factors from every nook and corner of these nations. It is relatively easier to diagnose coronary artery disease (CAD) than RHD because any patient with chest pain is given the benefit of doubt and taken up for management of CAD, whilst any case of arthritis is not considered as rheumatic fever (RF) and most cases are diagnosed only after valvular heart disease has occurred. This is because the Jones criteria for diagnosis is rather complicated for the general practitioners to apply. If the diagnosis of RF and RHD was simplified and only migratory arthritis and / or carditis with history of sore throat were given sufficient importance to start early prophylaxis then certainly the incidence of RF and RHD can be made negligible in coming years. There is no specific set of symptoms, signs or laboratory test diagnostic of ARF. Jones criteria makes sense only when applied along with a strong clinical suspicion and judgment. In a developing country like India, it is always better to over-diagnose RHD rather than under-diagnose by strict adherence to the Jones criteria. Proper and complete treatment of the initial attacks of RF and follow-up with prophylactic therapy are very important to prevent the potentially devastating complications, and curb the disease. Each year more than 4 million patients are admitted with unstable angine/acute myocardial infarction all over the world, whereas according to WHO the number of children in the world