These children are often underweight and have delayed developmental milestones due to their heart disease. Their schooling may be interrupted. On examination they have signs of leaking (incompetent) or narrowed (stenotic) heart valves. They may also have signs of heart failure.
These children are at great risk of developing infective endocarditis after dental procedures (bacteria enter the blood stream and then stick to the heart values where they cause infection and damage). The dentist should give a dose of prophylactic antibiotic before the procedure.
A large single oral dose of amoxycillin or clindamycin an hour before dental extraction reduces the risk of bacterial endocarditis on damaged valves.
Children with chronic rheumatic heart disease must be managed by a special cardiac clinic team. It is very important that they do not have any further attacks of rheumatic fever. Most children can be managed with drugs to control heart failure but some will require cardiac surgery.