<![CDATA[Rheumatic heart disease (RHD) is a major burden in nations with low or middle incomes. Malnutrition is a typical issue that sets off a vicious cycle in which increasing cardiac dysfunction worsens nutritional status. As a result, patients' clinical conditions rapidly deteriorate. We report the case of a 12-year-old boy, previously diagnosed with RHD but lost to follow-up, who came to the ER with symptoms of acute heart failure in a chronic condition. Clinical examination showed extensive anasarca, a typical heart murmur, and signs of muscle atrophy. Echocardiography confirmed severe mitral regurgitation and moderate tricuspid regurgitation. Severe hypoalbuminemia (2.8 g/dL) also confirmed the patient's poor nutritional status, indicating a poor catabolic state, which contributed to the acute cardiac event. Because of the complexities of handling both of these concurrent medical conditions, the patient was transferred to a tertiary hospital for further treatment after stabilization in the ICU. The increasing complexity of RHD, non-adherence with treatment, and malnutrition will considerably worsen the patient's prognosis. Integrated and multidisciplinary management, emphasizing nutritional support and intense treatment adherence education, is a long-term strategy for breaking the vicious cycle in vulnerable populations.]]>
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