This document discusses strategies for preventing rheumatic heart disease. It outlines four levels of prevention: primordial, primary, secondary, and tertiary. Primordial prevention focuses on societal interventions to improve living standards and access to healthcare. Primary prevention aims to treat streptococcal pharyngitis with penicillin. Secondary prevention, the most commonly used strategy, provides ongoing treatment to those diagnosed with rheumatic fever to prevent recurrences. Tertiary prevention seeks to improve symptoms, prevent complications like heart failure, and provide interventions for issues like atrial fibrillation.

1. Rheumatic heart disease
Preventative Strategies

2. Parkinson J. Rheumatic fever and heart disease:
the Harveian oration.Lancet. 1945;246:657–663
“Most deadly enemy of youth.”

3. Because it the problems of my country and my neighbours
“But there is ongoing controversy
on the optimal strategy”

4. Levels

5. Primordial
None would argue that primordial prevention—societal and community
interventions to raise the standard of living, improve access to health
care, and education to increase awareness of sore throats, in general,
and cardiac symptoms, in particular—is an essential component of any
preventative strategy. Vaccine is still a dream.
Marijon E, Mirabel M, Celermajer DS, Jouven X. Rheumatic
heart disease.Lancet. 2012;379:953–964.

6. Primary
Penicillin during the initial pharyngitis
Pharyngitis in young children is extremely
Common One-third of the cases are
associated with GAS, this strategy must
either include microbiological testing for
GAS, which itself is costly, or alternatively
include a clinical algorithm whose accuracy
is controversial.Nevertheless,using a
Markov model to test the cost-effectiveness
of treatment with intramuscular penicillin
based on various permutations of a clinical
algorithm and throat cultures, Irlam et al
concluded that treating all patients with
pharyngitis is the least costly, but that a
strategy of using a clinical decision rule
without culturing is the preferred approach.
Wessels MR. Streptococcal pharyngitis. N
Engl J Med. 2011;364:648–655.
Karthikeyan G, Mayosi BM. Is primary
prevention of rheumatic fever the missing
link in the control of rheumatic heart
disease in Africa?Circulation.
2009;120:709–713.
Irlam J, Mayosi BM, Engel M, Gaziano TA.
Primary prevention of acute rheumatic
fever and rheumatic heart disease with
penicillin in South African children with
pharyngitis: a cost-effectiveness analysis.
Circ Cardiovasc Qual Outcomes.
2013;6:343–351.

7. Secondary Prevention –WHO recommended
Secondary prevention is the most commonly practiced strategy,
because asymptomatic GAS pharyngitis is common, it targets
individuals with confirmed RF, is effective in preventing recurrences, is
the most cost-effective.
WHO. Rheumatic Fever and Rheumatic Heart Disease: Report of a WHO
Expert Consultation. Geneva 29 Oct–1 Nov 2001. Geneva, Switzerland:
WHO; 2004.

8. Tertiary prevention
• Improve the symptoms of RHD
• Prevention and treatment of heart failure
• Control of atrial fibrillation
• Anticoagulation
• percutaneous or surgical intervention

9. Time changes thing
James Watson, the molecular
biologist who has become nearly
as famous for his unfiltered, off-colour
remarks as for his role in
the discovery of the double-helix
structure of DNA, has achieved
another scientific milestone. On 4
December, he became the first
living scientist to auction his
Nobel Prize medal to the highest
bidder