Definition

Rheumatic heart disease is characterized by permanent damage to the heart valves caused by rheumatic fever. Rheumatic fever is caused by an inflammatory process that primarily affects the heart, joints, skin, and brain.

Rheumatic heart disease continues to have a devastating impact, accounting for nearly 300,000 deaths worldwide.

Causes

Rheumatic heart disease is caused by rheumatic fever. Rheumatic fever is caused by a throat infection with Streptococcus bacteria and scarlet fever that is not treated properly. Group A Streptococcus bacteria, or GAS, can cause these throat infections and scarlet fever.

Heart valve damage can occur shortly after a GAS infection, and the immune response causes an inflammatory condition in the body, potentially leading to long-term heart damage. The heart valves can become inflamed, leaving scars. This can cause heart valves to narrow or leak, interfering with the heart's normal function. This process can take several years and can result in heart failure.

Rheumatic heart disease is not contagious because it is an immune response rather than an infection. People with throat infections caused by GAS bacteria or scarlet fever, on the other hand, can spread GAS bacteria to others, particularly through respiratory droplets, if the infection is not treated properly.

Risk Factor

Rheumatic heart disease can affect anyone, but it is most common in school-aged children (ages 5 to 15). Rheumatic heart disease is extremely rare in children under the age of three and adults. Children with recurrent GAS throat infections are at the highest risk, particularly those who are not properly treated

Infectious diseases, including GAS infection, spread quickly when large groups of people gather. As a result, people living in densely populated areas are more likely to contract GAS throat infections or scarlet fever, which increases their risk of developing rheumatic heart disease. Such densely populated environments include:

• Schools
• Daycare centers
• Military training grounds

Furthermore, developing countries have a higher prevalence of the disease than developed countries due to poor health systems. People with low socioeconomic levels are also at high risk due to a lack of access to healthcare.

Symptoms

Symptoms of rheumatic fever vary and usually appear 1 to 6 weeks after a throat infection. In some cases, the infection may be so mild that it goes unnoticed. The most common symptoms of rheumatic fever are:

• Fever
• Joint pain with swelling and redness, especially in the knee and ankle joints
• Lumps under the skin
• A ring-shaped, raised, pinkish-colored rash, typically found on the chest, back, and abdomen
• Shortness of breath and chest discomfort
• Uncontrolled movements of the hands, feet, or facial muscles, called chorea
• Weakness

The symptoms of rheumatic heart disease are determined by the extent of damage to the heart valves, which may include:

• Shortness of breath, especially during exercise or lying down
• Chest pain
• Swelling, usually in the legs or lower limbs (due to gravity)

Diagnosis

A history of GAS throat infection or rheumatic fever is essential for diagnosing rheumatic heart disease. Physical examination will reveal abnormal heart sounds in patients with rheumatic heart disease. The abnormal sound is caused by blood leaking around the damaged valve. This abnormal sound may be accompanied by a scraping sound, which indicates movement or an inflamed heart.

Additional tests are usually required to diagnose rheumatic heart disease, including:

• Throat swab. The sample will be sent to the laboratory to determine whether the throat infection is caused by group A Streptococcus bacteria
• Blood tests. Some blood tests may be used to look for infection and inflammation
• Echocardiogram. This test uses sound waves to examine the heart's chambers and valves. Echo sound waves transmitted by a device placed on the skin above the heart produce images on a screen. It may reveal valve damage, blood backflow from leaking valves, fluid in the heart, and heart enlargement. This test is the most effective for detecting heart valve abnormalities
• Electrocardiogram (ECG). This test measures the strength and timing of the heart's electrical activity. The ECG will reveal abnormal rhythms and may also detect heart muscle damage. Small sensors will be attached to your skin to record your heart's electrical activity
• Chest X-ray. This may be done to check the lungs and look for heart enlargement
• Cardiac MRI. This produces detailed images of the heart, allowing for a more detailed and clear view of the heart valves and muscle

Management

The severity of heart valve damage determines how rheumatic heart disease is treated. In severe cases, surgery may be necessary to repair or replace the damaged valve with an artificial one. Early surgery can reduce the likelihood of developing heart failure, disability, or death.

The best treatment is to prevent rheumatic fever. Penicillin antibiotics are usually effective in treating Streptococcus infections and preventing rheumatic fever. Meanwhile, anti-inflammatory medications like aspirin, steroids, or NSAIDs can help to reduce inflammation and lower the risk of heart disease. If heart failure has occurred, other medications are needed to treat the heart failure.

People who have had rheumatic fever are usually given antibiotics daily or monthly, depending on the type of antibiotic chosen. This antibiotic therapy may be given for life to prevent recurrent infections and lower the risk of further heart damage.

Complications

Some complications of the heart disease of the rematics are:

• Heart failure. This can be due to a heavy narrowing or valve leak
• Bacterial endocarditis. This is a deep-heart infection and can occur if there is heart valve damage
• Complications of pregnancy and childbirth due to heart damage. Therefore, women with heart disease should consult a doctor if they want to plan a pregnancy
• Broken heart valves. This condition is a medical emergency condition and must be treated immediately with surgery to replace or repair heart valves

Prevention                           

Some complications of rheumatic heart disease are:

• Heart failure. This can result from severe valve narrowing or leakage.
• Bacterial endocarditis. This is an infection of the inner lining of the heart and can occur if there is damage to the heart valves.
• Complications of pregnancy and childbirth due to heart damage. Women with rheumatic heart disease should consult a doctor if they want to plan a pregnancy.
• Heart valve rupture. This is a medical emergency and should be treated immediately with heart valve replacement or repair surgery.

When to See a Doctor?

If you have symptoms of rheumatic heart disease, consult with a doctor immediately.