Dr. Prakash Raj Regmi MD Senior Consultant Cardiologist National Academy of Medical Sciences, Kathmandu, Nepal

1. Prevention of RF/RHD
Dr. Prakash Raj Regmi MD
Senior Consultant Cardiologist
National Academy of Medical Sciences,
Kathmandu, Nepal

2. Learning Objectives
1. To understand the comprehensive approach
in RHD prevention
2. Be familiar with all 4 methods of RHD
prevention

3. INTRODUCTION
RHD prevention methods
• Primary prevention
• Secondary prevention
• Tertiary prevention
• Primordial prevention

4. The 5 steps in RHD
RHD development steps
I. Risk factors of throat infection
II. Throat infection
III. Acute Rheumatic Fever
IV. Rheumatic Heart Disease
V. Complications of RHD- CCF, IE, Stroke, death

5. Primary Prevention
• Prevent development of RF/RHD
• Treatment of Sore Throat
• Inj. Benzathine penicillin G
1M once
• Tab.Penicillin V QID 10 days
• Amoxycillin TDS 7-10 days

6. Secondary Prevention
• Prevent recurrence of RF
• Prevent progression of RF to RHD
• Prevent progression of valve damage in RHD patients
• Inj.Benzathine Penicillin every 3 wks

7. Secondary Prevention
How long ?
• RF without carditis:
• RF with carditis but no
residual valvular
disease:
• RF with residual
valvular disease:
5yrs or until age 18
whichever is longer
10yrs or until age 21
whichever is longer
At least 10 yrs after last
episode and at least until
age 40.
sometimes Lifelong

8. Tertiary Prevention
• Prevent complications of RHD like CCF,
Thromboembolism, Infective endocarditis, death
Methods:
• Medical – Digoxin, Lasix, antibiotics, Warfarin
• PTMC
• Valve Replacement
• PT/INR monitoring

9. Primordial Prevention
• Prevent development of throat infections
Methods:
• Health promotion
• Increase in living standard
• Decrease overcrowding
• Yoga
• Vaccines

10. Take home message
1. There are 4 methods of RHD prevention
2. All 4 methods are equally important for RHD
prevention.