What Is Rheumatic Heart Disease?

Overview

Rheumatic heart disease is the damage of the heart valve due to one or several episodes of rheumatic fever.

When a streptococcal infection such as strep throat or scarlet fever remains untreated or under-treated, it results in damage to the heart valve shortly after infection.

An inflammatory condition in the body results from immune response which further leads to ongoing damage of the heart valve.

According to the World Health Organization (WHO), Rheumatic heart disease is most commonly developed in people under the age of 25 years. 

Causes of rheumatic heart disease

Rheumatic heart disease is caused by rheumatic fever which leads to heart valve inflammation. This damage of the heart valve may occur right away or by several episodes of the streptococcal infections. This prolonged inflammation may lead to scarring and narrowing of heart valve.

Rheumatic heart disease affects the mitral and aortic valves of the heart. These valves are responsible for controlling the flow of blood. The inefficiency of the heart valve to work properly leads to the leaking of blood backwards into the heart instead of flowing outward.

Signs and symptoms of rheumatic heart disease

The symptoms one can see in Rheumatic fever are:

• Painful joints especially involving the ankles, knees, elbows and wrists.
• Chorea: this is an uncontrollable jerky movement of body
• Heart murmur
• Fever
• Painless nodules are seen under the skin, near joints and/or a rash which consists of a ring which is pinkish in color with a clear center. However, these findings are rarely seen clinically. 

The common symptoms associated with rheumatic heart disease are:

• Shortness of breath
• Discomfort or chest pain 
• Swelling of  the hands, feets or abdomen
• Fatigue
• Rapid or irregular heartbeat

Management and treatment for rheumatic heart disease

There is no currently known method to permanently cure rheumatic heart disease. But with treatment, one can manage the symptoms and can also delay the progression of the disease. The treatment includes:

• Medication: the healthcare provider usually recommends medications to manage an abnormal heartbeat. The risks of strokes or blood clots can be reduced by using Anticoagulants ( blood thinner)
• Surgery: heart valve surgery is performed in severe cases of rheumatic heart disease. The heart valve is repaired or completely replaced by the surgeon

How is the repair of heart valve performed:

The heart valve repair surgery is also known as balloon valvuloplasty. In this procedure the surgeon does following:

• A catheter, which is a thin flexible tube is inserted through a small incision either in your leg or chest.
• Then a deflated balloon is funneled through the catheter to your damaged heart valve
• Then the balloon is inflated inside the valve. The opening of the balloon will help in improving the blood flow

How is the replacement performed for heart valve

The valve replacement surgery is performed when the repair of the heart valve cannot be performed. With the help of an artificial valve or tissue valve the heart valve is replaced by the surgeon. In some of the cases, Ross procedure may be performed by your surgeon. 

Diagnosis of rheumatic heart disease

Rheumatic heart disease is diagnosed by your healthcare provider by:

• Evaluating your symptoms
• performing a physical examination
• Analyzing your health history, especially any history of fevers or bacterial infections.

Following tests are used by your healthcare provider for the diagnosis of the heart valve disease:

• Blood tests: this test is performed to check for an inflammation or a high immune response
• Echocardiogram: this is the ultrasound of the heart. This test helps to find the leaky or narrowed heart valves
• Electrocardiogram: this is the test of the heart’s electrical activity to check the heartbeat

Risk factors

Usually children and adolescents are most commonly affected by rheumatic heart disease, in low and middle income countries, especially in the countries where poverty is widespread and there is limited access to the healthcare services.The people who live in overcrowded and in poor conditions are more prone to develop rheumatic heart disease. 

Rheumatic heart disease is the principal heart disease seen in pregnant women, which causes significant maternal and perinatal morbidity and mortality.

The pregnant women suffering from rheumatic heart disease are at great risk of adverse outcomes, which include heart failure and heart arrhythmias.

Complications

The complication due to rheumatic heart disease are as follow:

• Atrial fibrillation: the abnormal heartbeat present in the upper parts of the heart that will prevent the normal flow of blood
• Arrhythmias: means abnormal heartbeat
• Heart failure: the heart fails to pump blood

Any of these complications can increase the chances of strokes or blood clots. 

FAQs

How can I prevent rheumatic heart disease

Rheumatic heart disease can be prevented by taking antibiotics when the first signs of streptococcal infection occur. One should visit to healthcare provider when you or your child has:

• Joint pain
• Sore throat
• Muscle pain
• Tonsillitis (swollen tonsils)
• Fever
• Chorea ( jerky uncontrollable movement of the body) 

How common is rheumatic heart disease

Rheumatic heart disease is rarely seen in developed countries like the USA but it is mostly seen in the low-income or developing countries of the world. Approximately 300,000 people die worldwide each year due to rheumatic heart disease.

When should I see a doctor

One should contact their doctor if one experience new or worsened symptoms, including:

• Chest pain
• Confusion
• Difficulty in breathing
• Swelling or chest pain in your lower parts of the body

Summary

Rheumatic heart disease is the damage of the heart valve due to rheumatic fever, an  immune response of the body to untreated or under-treated bacterial infection. Rheumatic heart disease can even lead to heart failure. People suffering from this condition need careful monitoring and treatment.