Rheumatic heart disease: symptoms, causes, and treatment

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Definition of rheumatic heart disease

What is rheumatic heart disease?

Rheumatic heart disease is a condition of the heart valves that have been permanently damaged due to rheumatic fever. So, it can be said that this heart disease is a complication of rheumatic fever and that means that rheumatic fever and rheumatic heart disease are two different conditions.

Heart valve damage can start after a bacterial infection Streptococcus pyogenes (group A streptococcus) which causes sore throat or scarlet fever and is not being treated or is not properly treated.

The bacteria can easily pass from person to person in the same way as other upper respiratory infections. This strep infection occurs most often in childhood.

In some people, repeated strep infections cause the immune system to react to body tissues, causing inflammation and scarring of the heart valves.

How common is this disease?

Rheumatic heart disease is a common condition, especially in children who have recurrent throat infections. The age range of children at risk for the condition is about 5 to 15 years.

Signs & symptoms of rheumatic heart disease

Symptoms of a disease that attacks the heart may not appear for years. The onset of symptoms can vary from person to person. This depends on the part of the heart that is damaged and how severe the damage is. Usually, symptoms will appear after two weeks of infection.

Symptoms of rheumatic heart disease that generally occur are:

• Fever.
• Lumps appear under the surface of the skin.
• Red rash on the chest, back and abdomen.
• Shortness of breath and discomfort in the chest.
• Limp.
• Uncontrolled movements of the muscles of the hands, feet or face.
• Heart murmur during activity.

Most of the sufferers of this disease also have a similar characteristic, namely the presence of a sound similar to friction in the heart that can be heard using a stethoscope.

In severe cases, this rare disease can cause difficulty breathing after exertion, chest pain, and swelling of the area.

When to see a doctor

If you or your little one experiences the symptoms above, especially those that lead to heart disease such as chest pain and shortness of breath, see a doctor immediately.

Causes of rheumatic heart disease

The main cause of rheumatic heart disease is rheumatic fever that is not treated properly. When rheumatic fever occurs, the immune system carries out a defense which ends up attacking many body tissues, especially the heart, joints, skin, and brain.

This inflammation causes the heart valves to become inflamed, injured, and damaged over time, making it difficult for the heart to function normally.

Risk factors for rheumatic heart disease

The following are some of the factors that can increase the risk of complications from rheumatic fever:

• Children who have repeated strep throat (pharyngitis) infections.
• People who have rheumatic fever.

Complications of rheumatic heart disease

This disease that attacks the heart valves can cause complications including:

• Heart failure. Heart failure is a complication caused by narrowed or leaking heart valves.
• Endocarditis. Endocarditis is an infection of the inner lining of the heart that can occur when rheumatic fever has damaged the heart valves.
• Heart valve burst. These emergencies must be treated with surgery to replace or repair a broken heart valve.
• Complications of pregnancy and childbirth. Complications can include arrhythmias and heart failure due to increased blood volume which puts more pressure on the heart valves.

Diagnosis & treatment of rheumatic heart disease

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

If your doctor suspects that your symptoms suggest rheumatic heart disease, a throat tissue culture test will be done. The goal, to determine the presence of strep bacterial infection. Then, during a routine check-up, your doctor may find a heart murmur.

A heart murmur is a whooping sound in the heart that can be a sign of inflammation of the heart or leakage of a damaged heart valve.

In addition to the tests above, your doctor may also ask you or your little one to take a series of medical tests, such as:

• Echocardiography

Echocardiography tests use sound waves to examine the chambers and valves of the heart. The sound waves will produce an image on the screen as the ultrasound transducer passes through the skin over the heart.

These waves can indicate damage to the valve flap, backflow of blood through the leaky valve, fluid around the heart, and an enlarged heart. This medical test is very commonly used to detect problems with heart valves.

• Electrocardiogram (EKG)

An EKG test records the strength and electrical activity of the heart. It shows the rhythm of the heart's rhythm and can sometimes detect damage to the heart muscle. Small sensors are placed against your skin to detect electrical activity.

• Imaging test

Imaging tests such as chest x-rays and cardiac MRO will also need to be done. The goal is to see an enlarged heart (cardiomegaly) and see a clearer picture of the valves and heart muscle.

• Blood test

Blood tests are usually done to detect a bacterial infection by looking at the white blood cell count and inflammation.

What are the treatment options for heart disease?

Reporting from the John Hopkins Medicine page, treatment largely depends on how much damage has been done to the heart valve. In severe cases, treatment may include surgery to replace or repair a badly damaged valve.

The best treatment is to prevent rheumatic fever from getting worse. Antibiotics can usually treat strep infections and prevent the development of rheumatic fever.

Anti-inflammatory drugs can also be used to reduce inflammation and lower the risk of heart damage, for example aspirin or steroids. Your doctor may also prescribe medication for heart failure if needed.

People who have had rheumatic fever are often given daily or monthly, or even life-long, antibiotic treatment to prevent recurrent infections and lower the risk of further heart damage.

Home treatment of rheumatic heart disease

Apart from undergoing treatment at the hospital, patients may also be asked to apply home treatments, such as:

• Limiting certain activities according to the condition of the damage that occurs to the heart, for example in undergoing sports.
• Eat healthy and nutritious foods to boost your immune system and maintain overall health.

Prevention of rheumatic heart disease

Even though it is included in the category of heart disease, its preventive measures are not entirely the same as how to prevent heart disease in general.

One way to prevent rheumatic heart disease is to prevent streptococcal bacterial infection. So, if you are already infected, treat it immediately by taking an antibiotic prescribed by your doctor, for example benzathine penicillin G, which is given by intramuscular injection every 3-4 weeks for years.