Complications
Around 30% to 50% of all patients with rheumatic fever will develop rheumatic heart disease, and this risk increases to more than 70% if the initial attack is severe or if there has been at least one recurrence. Typically this affects the mitral valve, but mixed aortic and mitral disease can occur. This may be detected through routine follow-up or if the patient develops symptoms of breathlessness or decreased exercise tolerance. The extent of valve damage can be monitored by echocardiography, and valve repair or replacement surgery may be required. Mitral valve repair is preferred to replacement as patients are young and a replacement tissue valve is only likely to last up to 15 years. The alternative is a mechanical valve requiring lifelong anticoagulation. Additional complications include atrial fibrillation and congestive heart failure.[121]
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