Rheumatic heart disease screening in resource limited settings: is hand held device the answer?
I would like to thank Drs. Godown and Beaton for their letter in response to the recent editorial published in this journal (1). I entirely agree with their view that early diagnosis of rheumatic heart disease (RHD) provides the opportunity for initiating secondary prophylaxis. It is also established that progression of valvular damage can be arrested by effective secondary prophylaxis, as it prevents recurrent streptococcal infections. The moot question is how we effectively identify patients with RHD, early. This question assumes further importance in resource poor settings where the burden of RHD is likely to be high. Auscultation has been shown to be ineffective due to its poor sensitivity and specificity for mild or very mild cases of RHD. A number of studies published in the last decade have established the role of echocardiography in early RHD diagnosis. Data from all these studies has shown a much higher prevalence of RHD than the clinical estimates, based on auscultation. There was no uniformity in diagnostic criteria in many of these studies, making their interpretation difficult. To avoid this, World Heart Federation came up with specific criteria for diagnosing definite and borderline RHD by echo-Doppler. These criteria were developed for conventional and portable echocardiographic equipment.