The echocardiographic data in our patients suggests that rheumatic myocarditis, reflected as impaired diastolic and/or systolic function, is not apparent in this patient group and that the elevated NT-proBNP was due to uncontrolled heart failure as a consequence of the entire “pancarditis” process, of which rheumatic valve affection was probably the major contributor. Here, NPPB is linked to heart failure.