Rheumatic valvular heart disease and unaffordable surgical interventions in a finance-limited setting

Background: Heart failure in the young is usually associated with non-communicable etiology. Rheumatic valvular heart disease (RVHD) is a common cause of heart failure in this age and usually presents with heart failure. The management of RVHD may require medical and surgical interventions. Here is documented a case of RVHD requiring both medical and surgical interventions, but the patient could not afford the counterpart fund for the surgery and has been hanging in the balance. Findings: The patient, a 28-year old woman, presented with features of heart failure – breathlessness on mild exertion, orthopnea, paroxysmal nocturnal dyspnea, tiredness and lower limb swelling that waxed with exertion, of 2 months, mild respiratory distress, pallor, lower limb edema, irregular pulse, normal blood pressure, displaced cardiac apex, pansystolic murmur and basal lung crepitation. She also has an enlarged pulsatile liver and ascites. CXR showed cardiomegaly, unfolded aorta and upper lobe vascular diversion. Echocardiography showed global hypokinesia, aortic stenosis, mitral stenosis, tricuspid and pulmonary regurgitation, EF 36%, FS 28%, septal thickening and LVH. ECG showed evidence of ST T changes in the lateral leads. She was placed on anti-failure regimens. For a period of about 8 months, she was not able to source the counterpart fund necessary to effect a valvular heart surgery. As a result, she could not undergo any heart surgery. Conclusion: Surgical interventions for RVHD are not readily available neither are they accessible to patients needing them, as with our index patient.