The clinical manifestations of rheumatic heart valve disease are regardless of age: 1. Mitral stenosis Most of the early mild mitral stenosis has no obvious symptoms. In left heart failure, dyspnea (exertional dyspnea, paroxysmal nocturnal dyspnea, acute pulmonary edema), cough, sputum, hemoptysis, lethargy, cyanosis and other manifestations may appear. In right heart failure, symptoms such as jugular vein anger, liver enlargement with pressure pain, and concave swelling of lower limbs may occur. Ascites and cardiogenic cirrhosis may occur in late stages. The patient has a mitral face, cyanosis of the lips and mouth, and dark red cheekbones. An elevated precordial area indicates significant cardiac hypertrophy (predominantly right ventricular hypertrophy). Diastolic tremor is palpable at the apex of the heart. The normal heart waist disappears and the turbinate border is pear-shaped. The first heart sound is often augmented. A diastolic rumble-like murmur can be heard in the apical region during auscultation. 2, mitral valve insufficiency mitral valve insufficiency is mostly rheumatic, about 50% of people combined with mitral stenosis. Mild and early mitral valve insufficiency can be no obvious symptoms, and asymptomatic period is quite long. However, once symptoms occur, they are more severe. In more severe cases, symptoms of left heart insufficiency, such as exertional dyspnea and paroxysmal nocturnal dyspnea, and sometimes right heart failure may occur, but acute pulmonary edema and hemoptysis are less common. The patient may feel lethargy, palpitations and weakness when the cardiac output is reduced. The patient’s apical pulses are shifted to the lower left, with elevated apical pulsations. However, mitral valve facies are absent in mitral valve insufficiency. There is occasional systolic tremor on palpation of the apical region. The left ventricular hypertrophy and dilatation result in an enlargement of the turbinate to the lower left. The second heart sound in the pulmonary valve area is hyperactive. A loud and rough III can be heard in the apical region. Systolic murmurs are heard above the systolic level. It is conducted to the left axillary area. 3.Aortic stenosis Simple aortic stenosis caused by rheumatic heart disease is rare. In mild stenosis, there is little hemodynamic impact; in moderate to severe stenosis, the left ventricular blood drainage is blocked and cardiac output is reduced, resulting in inadequate myocardial blood supply and angina pectoris. Mild aortic stenosis is mostly asymptomatic. When the stenosis worsens, exertional dyspnea and fatigue may occur, and later dizziness and syncope, angina, and left heart failure may occur. A small number of people are prone to sudden death, mainly due to complications of coronary thrombosis, which leads to high atrioventricular block induced ventricular fibrillation or cardiac arrest. The patient’s apical beats are shifted to the lower left and the beats are diffuse. Systolic tremor may occasionally be palpated on palpation. Left ventricular hypertrophy causes the patient’s turbinate to widen to the left inferiorly. The second heart sound in the aortic valve area is diminished. A loud and rough systolic blowing murmur can be heard in the first auscultatory region of the aortic valve. 4, aortic valve insufficiency In rheumatic heart disease, it is rare to involve the aortic valve alone. Compared with aortic stenosis, aortic valve insufficiency occurs earlier, but is often accompanied by varying degrees of stenosis. The compensatory period of rheumatic aortic valve insufficiency is quite long, and mild cases can be maintained for more than 20 years without pulmonary stasis, so they are often asymptomatic. In late stages, left heart failure and pulmonary stasis develop, and angina pectoris may occur, and eventually right heart failure may also manifest. Patients may show peripheral vascular signs, such as significant carotid artery pulsation, rhythmic head nodding due to pulsation, positive capillary pulsation, increased pulse pressure, and watery pulse. The apical pulsation may be elevated and shifted to the left. The cloudy heart border is enlarged to the lower left. On auscultation, a rough and loud diastolic blowing murmur can be heard in the second auscultatory region of the aortic valve. Gunshot sounds and Duchenne double sounds are heard in the middle. 5, complications (1) respiratory tract infection, long-term pulmonary stasis easily leads to lung infection, which can further aggravate or induce heart failure. (2) Heart failure, which is the most common complication of wind heart disease and the main cause of death. (3) Arrhythmias, all kinds of arrhythmias can occur, with atrial fibrillation being more common. (4) Subacute infective endocarditis, in which patients may present with progressive anemia, persistent fever, bruising, embolism, pestle fingers, and splenomegaly. (5) Embolism, caused by detachment of the attached thrombus, cerebral embolism is the most common.