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Rheumatic Heart Disease

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  3. Rheumatic Heart Disease

Overview of Rheumatic Heart Disease

Rheumatic heart disease is a serious medical condition in which heart valves are permanently blocked due to rheumatic fever. This is also considered a critical complication of rheumatic fever. 

Rheumatic fever is an inflammatory autoimmune disease produced when strep throat or scarlet fever is not treated properly. Both strep throat and scarlet fever are caused due to streptococcus (strep-toe-KOK-us) bacteria.

Furthermore, when rheumatic fever attacks the heart valves, it may start to damage because of untreated streptococcal infections such as strep throat or scarlet fever. An immune response produces an inflammatory action which continues further valve damage. If the valve disruption is not treated properly, then it may cause heart failure.

Signs and Symptoms of Rheumatic Heart Disease

Rheumatic fever is the prime marker of the diagnosis of rheumatic heart disease. The symptoms of rheumatic fever differ as per the severity of the condition. The symptoms typically begin 1 to 6 weeks after the initiation of strep throat. 

The most familiar symptoms of rheumatic fever are given below:

  • Fever
  • Swollen, tender, red, and extremely painful joints (particularly the knees and ankles)
  • Nodules (lumps under the skin)
  • Red severe rashes, usually on the chest, back, and abdomen
  • Shortness of breath and chest discomfort
  • Uncontrolled movements of arms, legs, or facial muscles
  • Weakness

Symptoms of rheumatic heart disease based on the severity of valve damage may include:

  • Shortness of breath (especially with activity or when lying down)
  • Chest pain
  • Swelling

Types of Rheumatic Heart Disease

Causes of Rheumatic Heart Disease

Acute rheumatic fever can stimulate inflammation of the heart. This inflammation causes damage on the different sides of the heart such as,

  • The surface of the heart (pericarditis)
  • Within the heart (endocarditis)
  • Involving the heart muscle itself (myocarditis)

If an individual is experiencing endocarditis, the inflammatory response can cause subsequent blockage to one or more of the four heart valves. If it is not treated properly, this disruption gets worse as time passes by.

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Risk Factors of Rheumatic Heart Disease

Who is at Risk? 

As you know, rheumatic heart disease is associated with rheumatic fever. A person who suffers from rheumatic fever may have a risk of rheumatic heart disease. These are other factors that can increase the risk of rheumatic fever include:

  • Family History: People who have a genetic history of rheumatic fever are more prone to this fever.
  • Type of Streptococcal Bacteria: People exposed to the strains of streptococcus bacteria may have a chance of rheumatic fever.
  • Environmental Factors: People who are living in overcrowded, poor sanitation and other unhygienic areas are more prone to streptococcus bacteria that lead to rheumatic fever. 

 

These factors of rheumatic fever will ultimately cause rheumatic heart disease in people. But children suffer more especially those who had a recurrence of strep throat infection as compared to adolescents.

Health Complications of Rheumatic Heart Disease

Rheumatic heart disease can arise with different complications depending on the type and number of affected valves and how much the valve has been damaged.

These are the most common forms of health complications that are related to rheumatic heart disease:

  • Mitral Valve Disease- It is caused by the deposition of excessive calcium on the mitral valve. The mitral valve typically allows the blood to flow from the left atrium to the left ventricle. Because of the accumulation of calcium, blocks the valve from completely opening (mitral stenosis). This is referred to as a leaky valve or commonly termed mitral regurgitation.
  • Aortic Valve Disease- It works the same as mitral regurgitation but affects the aortic valve (which separates the left ventricle from the aorta), despite the mitral valve. These accumulations of calcium can result in the cause of aortic stenosis, aortic regurgitation, or both.
  • Tricuspid Valve Disease or Tricuspid Regurgitation- It involves the tricuspid valve (which separates the right atrium from the right ventricle), but the condition is commonly the same as aortic and/or mitral valve disease.
  • Atrial Fibrillation is associated with rheumatic mitral stenosis, in which rapid and abnormal heart rate is observed.

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Prevention

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Diagnosis

People having rheumatic heart disease will have or had a streptococcal infection history. At that moment, a throat culture or blood test is recommended to check the presence of streptococcus bacteria.

The first sign of having rheumatic heart disease is low sound or rub that may be detected during a routine physical exam. The low sound voice is caused by the leakage of blood surrounding the damaged valve. The rub is caused when the heart tissues become inflamed and rub against each other.

When the doctors have obtained the complete medical history and done the physical examination, then they recommend diagnostic tests for the rheumatic heart disease for the patients that are:

1. Echocardiogram (echo)

The ECHO test is carried out to check the state of the heart's chambers and valves by passing the sound waves in the heart. This creates a picture on a screen as an ultrasound transducer passes over the skin covering the heart. It revealed a detailed view of the areas of the damaged heart that are.

  • Valve flaps damage
  • Blood backflow through a leaky valve
  • Accumulation of fluid surrounding the heart
  • Enlargement of heart 

This technique is most useful to diagnose the exact area of heart valve problems. 

2. Electrocardiogram (ECG):

The ECG test applies to record the strength and timing of the electrical activity of the heart by connecting the small sensors tapped with the skin. It also displays abnormal rhythms (arrhythmias or dysrhythmias) and can sometimes detect heart muscle damage. 

3. Chest X-ray:

The Chest X-ray is used to check the size of the heart or the deposition of any fluid in the heart or lungs. 

4. Cardiac MRI

The MRI test is an imaging test to see detailed pictures of the heart. It gives the most precise look at the heart valves and muscles.

Treatment of Rheumatic Heart Disease | When to Consult a Doctor

Treatment varies according to the intensity of damaging the heart valves. Surgery is the last option for treating chronic rheumatic heart disease and is beneficial for valve replacement. 

Medications:

The best treatment is to manage rheumatic fever through antibiotics. These antibiotics can usually treat strep infections and prevent rheumatic fever. Anti-inflammatory drugs may be used to lessen inflammation and lower the risk of heart damage. Other medicines may be required for heart failure management. 

These antibiotic medications are given to the patients on a daily or monthly basis to prolong their lives, prevent relapse of infections, and reduce the risk of more heart damage. Certain steroids, non-steroidal medicines, or aspirins may be given to reduce inflammation.

You need to consult a certified cardiologist or cardiac surgeon for a customized treatment plan. 

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