Rheumatic fever is caused due to streptococcus infections. The patient experiences fever, fatigue, and joint pain. Recurrent strep infections may result in inflammation due to activation of the immune system that may result in inflammation and scarring of the valves of the heart.

Ischemic stroke is one of the severe complications of rheumatic heart disease. The condition may result in disability and death. The author of the study wrote, “This study aimed to assess the incidence and predictors of stroke in patients with RHD in the current era of evidence-based recommendations for prevention.”

The patients with RHD were diagnosed through echocardiography and clinical assessment according to the criteria. At the time of enrollment, the etiology and classification of stroke were determined through structured neurological and clinical assessment. The primary endpoint of the study was a cerebrovascular event due to ischemia that includes non-fatal and fatal stroke.

There were a total of 515 patients enrolled in the study. There were 438 women included in the study. In almost 80% of the people, the valve lesion was mixed mitral. 92 patients were having a history of stroke with the most frequent topography being anterior circulation infarction. The mean follow-up period was 3.9 years. During the follow-up period, 5.2% of patients had a stroke with an incidence of 1.47 strokes per 100 patient-years. The predictors of stroke were determined through the Cox model. The predictors include age, atrial fibrillation, and history of stroke. The effect of atrial fibrillation on stroke risk was attenuated while considering death as a competing risk.


Vasconcelos M, Vasconcelos L, Ribeiro V, Campos C, Di-Flora F, Abreu L, Silva L, Diamantino T, Padilha da Silva JL, Esteves WAM, Teixeira AL, Nunes MCP. Incidence and predictors of stroke in patients with rheumatic heart disease. Heart. 2021 May;107(