RT Book, Section
A1 O’Gara, Patrick T.
A1 Loscalzo, Joseph
A2 Kasper, Dennis
A2 Fauci, Anthony
A2 Hauser, Stephen
A2 Longo, Dan
A2 Jameson, J. Larry
A2 Loscalzo, Joseph
SR Print(0)
ID 1120805690
T1 Aortic Valve Disease
T2 Harrison's Principles of Internal Medicine, 19e
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 9780071802154
LK accessmedicine.mhmedical.com/content.aspx?aid=1120805690
RD 2021/01/21
AB Primary  valvular  heart  disease  ranks  well  below  coronary  heart  disease,  stroke,  hypertension,  obesity,  and  diabetes  as  a  major  threat  to  the  public  health.  Nevertheless,  it  is  the  source  of  significant  morbidity  and  mortality  rates.  Rheumatic  fever  (Chap.  381)  is  the  dominant  cause  of  valvular  heart  disease  in  developing  and  low-income  countries.  Its  prevalence  has  been  estimated  to  range  from  as  low  as  1  per  100,000  school-age  children  in  Costa  Rica  to  as  high  as  150  per  100,000  in  China.  Rheumatic  heart  disease  accounts  for  12–65%  of  hospital  admissions  related  to  cardiovascular  disease  and  2–10%  of  hospital  discharges  in  some  developing  countries.  Prevalence  and  mortality  rates  vary  among  communities  even  within  the  same  country  as  a  function  of  overcrowding  and  the  availability  of  medical  resources  and  population-wide  programs  for  detection  and  treatment  of  group  A  streptococcal  pharyngitis.  In  economically  deprived  areas,  tropical  and  subtropical  climates  (particularly  on  the  Indian  subcontinent),  Central  America,  and  the  Middle  East,  rheumatic  valvular  disease  progresses  more  rapidly  than  in  more-developed  nations  and  frequently  causes  serious  symptoms  in  patients  younger  than  20  years  of  age.  This  accelerated  natural  history  may  be  due  to  repeated  infections  with  more  virulent  strains  of  rheumatogenic  streptococci.  Approximately  15  million  to  20  million  people  live  with  rheumatic  heart  disease  worldwide,  an  estimated  prevalence  characterized  by  300,000  new  cases  and  233,000  case  fatalities  per  year,  with  the  highest  mortality  rates  reported  from  Southeast  Asia  (~7.6  per  100,000).