What are the key clinical features to consider when diagnosing rheumatic heart disease in a patient with a history of rheumatic fever?

When diagnosing rheumatic heart disease (RHD) in a patient with a history of rheumatic fever, the history of rheumatic fever itself is a critical predisposing factor NICE NG143. The definitive diagnosis of RHD primarily relies on specific echocardiographic findings NICE NG208. The World Heart Federation (WHF) criteria provide an evidence-based guideline for the echocardiographic diagnosis of RHD Reményi et al. 2012. These criteria assess pathological changes in heart valves, such as mitral regurgitation, aortic regurgitation, mitral stenosis, and aortic stenosis Reményi et al. 2012. While echocardiography provides the diagnostic confirmation, the key clinical features that would prompt investigation and are associated with RHD are those of heart valve disease NICE NG208. These clinical features can include symptoms such as shortness of breath, fatigue, chest pain, and palpitations NICE NG208. On physical examination, the presence of heart murmurs is also a crucial clinical feature to consider NICE NG208.