Pulsatile drug delivery, circadian rhythms, Tiotropium Bromide, Lag time, Press coated tablets.

Rheumatic heart disease is chronic condition resulting from rheumatic fever which involves all the layers of the heart and is characterized by scarring and deformity of the heart valves. Around 60% of the acute rheumatic fever further develops in to rheumatic heart disease. Sore throat with fever, carditis, Erythema marginatum, polyarthritis are the main manifestations. Aggressive treatment with antibiotics and use of analgesics can cure the disease up to certain extent. Awareness of clinicians regarding diagnosis and accurate treatment can reduce the cardiac burden. Keywords: Rheumatic heart disease, Erythema