Abstract:
Rheumatic Heart Disease (RHD) remains a leading cause of cardiovascular morbidity and
mortality in low-income settings, highest burden being in sub-Saharan Africa. Benzathine
Penicillin G (BPG) is central to secondary prophylaxis, effectively preventing recurrent acute
rheumatic fever and progressive valvular damage. Severe adverse outcomes such as sudden
cardiac arrest (SCA) following administration have been reported, which is of concerns. This
study is to evaluate the potential association between BPG prophylaxis and sudden cardiac
arrest in patients with RHD, and to highlight clinical implications for monitoring, risk
stratification, and management. Patient with established RHD, developed sudden cardiac
arrest shortly after routine intramuscular BPG administration, despite having no preceding
allergic symptoms or conventional cardiovascular risk factors. ECG revealed T-wave
abnormalities, while echocardiography showed normal biventricular function with only trace
mitral regurgitation. Troponin levels were within normal limits, and no structural
abnormalities or ischemic changes were identified. The absence of severe valvular disease or
anaphylaxis suggests a transient arrhythmic event, potentially triggered by BPG injection.
While BPG remains indispensable in preventing acute rheumatic fever recurrence and
reducing long-term sudden cardiac arrest risk, its potential to trigger sudden electrical
instability, even in structurally normal hearts, needs clinical vigilance.
