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Rheumatic heart disease screening follow-up — RACP Adult Medicine MCQ

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HardAboriginal and Torres Strait Islander healthRheumatic heart disease screening follow-upRACP Adult Medicine

A 19-year-old Aboriginal woman from a high-risk community is pregnant and has a murmur plus an uncertain childhood history of acute rheumatic fever. She is asymptomatic. What investigation is most appropriate?

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Correct answer: E — Obtain transthoracic echocardiography to define valve morphology and haemodynamic severity

The best answer is “Obtain transthoracic echocardiography to define valve morphology and haemodynamic severity”. Echocardiography safely identifies characteristic valve disease and quantifies stenosis, regurgitation, chamber response and pulmonary pressure—information essential for pregnancy planning. ECG cannot exclude structural disease, an antibody titre reflects prior streptococcal exposure rather than chronic valve anatomy, and ionising coronary imaging is irrelevant.

Reference: RHD Australia: Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease: https://www.rhdaustralia.org.au/resources/2020-australian-guideline-for-prevention-diagnosis-and-management-of-acute-rheumatic-fever-and-rheumatic-heart-disease-3rd-edition