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What is Rheumatic heart disease?

Rheumatic heart disease (RHD) is a serious heart disease that affects one or more of the four small heart valves. Damage to the valve remains after an illness called acute rheumatic fever (ARF). During ARF, the tissue of the heart valve and sometimes other parts of the heart (lining of the heart or muscle) become inflamed and this is called carditis.

After carditis, the heart valves can be damaged, followed by scarring, and the result is disruption of normal blood flow through the damaged valves. Some of the blood may flow backward through a leaky valve that does not close properly, or a leaky, scarred valve may not open properly.


When the heart is damaged in this way, the heart valve may not function properly and heart surgery may be necessary to repair or replace the damaged valve. Routine antibiotics are prescribed for people with RHD to prevent recurrent ARF and subsequent valve damage.

Causes

Rheumatic heart disease is caused by rheumatic fever, which affects many connective tissues, especially the heart, joints, skin, or brain. Heart valves can become inflamed and scarred over time.


This causes the heart valve to narrow or leak, making it difficult for the heart to function normally. Years can take to develop and the heart can stop beating.Rheumatic fever can occur at any age, but most commonly occurs in children 5 to 15 years old. It is very rare in developed countries like the United States.

Risk factors

Risk factors for ARF and Rheumatic heart disease include age, sex, and various environmental factors (carapatis, et al., 2016). In terms of age, ARI mainly affects children between the ages of 5 and 14, and early ARI cases affect children under this age (Lawrence, Carpetis, Griffiths, Edwards and Condon, 2013; Parnaby and Carpetis, 2010) . Recurrent episodes usually affect older children and occur during adolescence.


Rheumatic heart disease is often caused by cumulative damage, with a peak prevalence of RHD occurring in a person in their 20s and 30s, although the burden of RHD in children and adolescents can be significant (Lawrence, Carpetis, Griffiths, Edwards and Condon, 2013).

Symptoms

Symptoms of rheumatic fever vary. You may have some or more symptoms and the symptoms may change as the disease progresses. The onset of rheumatic fever usually occurs two to four weeks after a strep throat infection.


Rheumatic heart disease doesn't always cause symptoms. When it does, symptoms may include:

  • Chest pain

  • Heart palpitations

  • Breathlessness on exertion

  • Breathing problems when lying down (orthopnoea)

  • Waking from sleep with the need to sit or stand up (paroxysmal nocturnal dyspnoea)

  • Swelling (oedema)

  • Fainting (syncope)

  • Stroke

  • Fever associated with infection of damaged heart valves.

Complications

The inflammation caused by rheumatic fever can last from a few weeks to several months. In some cases, inflammation can cause chronic problems.Rheumatic fever can cause permanent damage to the heart (rheumatic heart disease). It occurs 10 to 20 years after the actual illness, but severe cases of rheumatic fever can damage heart valves while your child is still showing symptoms.

Problems with the valve between the two left chambers of the heart (mitral valve) are common, but other valves are affected.

Treatment

Your cardiologist will determine the specific treatment for rheumatic heart disease based on:


  • your overall health and medical history

  • extent of the disease

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

 

Since rheumatic fever is the cause of rheumatic heart disease, prevention of rheumatic fever is the best treatment. Penicillin and other antibiotics can usually treat strep throat (Streptococcus a bacterial infection) and prevent the development of rheumatic fever.

Diagnosis

Your pediatrician first wants to get a list of your child's symptoms and medical history. They also want to know if your child has had a recent sore throat. Next, a physical exam will be done. Your pediatrician will do the following, among other things:

  • Examine your throat and sometimes blood for evidence of strep bacteria.

  • Perform movement tests to detect their nervous system dysfunction.

  • Look for rashes or nodules on the skin.Examine their joints for inflammation.

  • Listen to your heart for abnormalities.

  • Perform an echocardiogram, which uses sound waves to create images of their heart.

  • Perform an electrocardiogram (ECG or EKG), which measures the electric waves of their heart.

Prevention

Rheumatic fever can be prevented by treating strep throat quickly and effectively with antibiotics.In those who have had rheumatic fever in the past, antibiotics are sometimes recommended as a preventative measure. As of 2017, there is very little evidence to support chronic antibiotics in people with underlying disease.The American Heart Association recommends maintaining dental health, and those with bacterial endocarditis, heart transplantation, artificial heart valves, or "certain types of congenital heart defects" may consider long-term immunity to antibiotics.

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