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Rheumatic heart disease is a major burden in developing countries where it causes maximum cardiovascular morbidity and mortality in young people. Acute rheumatic fever is the precursor to rheumatic heart disease. ARF can lead to irreversible valve damage and heart failure. Mitral valve incompetence is the most common valvular lesion in patients with rheumatic heart disease, particularly in early stages. Mitral stenosis usually develops later. A transthoracic echocardiogram is sensitive and specific for detection of rheumatic heart disease.