Overview

Rheumatic fever, an acute fever, is caused by an infection marked by inflammation and joint pain. It usually affects individuals under the age of 20. If not treated promptly, it can lead to rheumatic heart disease. The damage and scarring of the heart valves may begin immediately after a streptococcal infection, such as strep throat or scarlet fever, mainly if the infection is left untreated or partially treated. This disease results from an immune reaction, which can cause severe damage to valves. Rheumatic heart disease can affect various connective tissues but is most commonly found in the heart, joints, skin, and brain.

Symptoms of Rheumatic Heart Disease

Rheumatic heart disease can only be diagnosed if the patient has had strep throat or rheumatic fever in the past several years. Rheumatic fever symptoms often appear anywhere from 1 week to 6 weeks after a case of strep throat has cleared up. The illness may have been too mild to be diagnosed, or it may have cleared up by the time the patient is examined. Some of the symptoms include -

- Joint pain, especially in the knees, ankles, elbows, and wrists
- Extreme tiredness
- Chorea (uncontrollable jerky movements)
- Painless nodules beneath the skin near joints
- A rash consisting of pink rings with a clear centre may also be present (both rare)
- A fluttering in the heart

Heart valve degeneration from rheumatic heart disease might cause symptoms such as

- Chest pain or discomfort
- Shortness of breath
- Swelling of the stomach, hands, or feet
- Fatigue
- Rapid or irregular heartbeat

Some children with rheumatic heart disease have no symptoms but may have chest pain, swelling, and shortness of breath with activity or lying down. They may also have other problems due to rheumatic fever, such as a sore throat and joint pain.

How Does It Affect?

When a person develops rheumatic heart disease, the heart valves have been damaged by a strep infection. This damage often occurs to the mitral (between the left atrium and left ventricle) or aortic valves.

In some people, repeated group A strep infections can cause the immune system to produce antibodies that attack healthy tissue, such as the heart valves. This can lead to inflammation, scarring, and permanent heart valve damage.

People with rheumatic heart disease are more likely to develop other diseases, including infections. They also have an increased risk of stroke. This is because the heart valves become damaged during a strep throat infection or rheumatic fever and can't heal properly. The resulting inflammation can lead to the valves narrowing or leaking, which makes it hard for the heart to work normally.

How Is Rheumatic Heart Disease Diagnosed?

Rheumatic heart disease can be diagnosed with tests, including a thorough patient history and physical examination.

- Physical examination – A cardiac murmur on physical examination suggests RHD, but many people have RHD and do not have murmurs.
- Medical histories – Such as the presence of ARF or acute rheumatic fever antibodies or strep test results.
- Chest x-ray – To see if the heart has increased in size or if there's fluid in the lungs.
- Electrocardiogram (ECG) – To see if there is an irregular heartbeat or enlargement of the heart's chambers (arrhythmia)
- Echocardiogram – This test uses sound waves to see how well the heart valves work and whether they are damaged. It can also show blood flow across a leaky valve, heart fluid, and chambers swelling.

Treatment Options For Rheumatic Heart Disease

Treatments for rheumatic heart disease vary depending on the patient’s age and health. It helps manage the symptoms and to prevent recurrences. These medicines help keep the valves in the heart healthy and prevent them from narrowing or leaking, which could cause damage to the blood vessels or lead to congestive heart failure.

Antibiotics

They are used to treat the infection that causes rheumatic fever and prevent the bacteria from coming back. The antibiotics also help to stop the inflammation from causing long-term problems.

Taking antibiotics like penicillin G benzathine as prescribed by a doctor is the best way to prevent rheumatic fever. The most important thing is to take them on time daily and follow the doctor's instructions.

Anti-inflammatory medications

In addition, doctors can prescribe medications such as Aspirin or naproxen to reduce inflammation. These include the need for aspirin to control joint inflammation and steroids to reduce the inflammation of the heart.

Surgery

Surgery to replace a damaged heart valve is another form of treatment for rheumatic heart disease. This may be done to repair a hole in a heart valve or replace a valve that is too narrow or leaks.

Prevention of Rheumatic Heart Disease

Rheumatic heart disease is extremely serious and can cause death if not promptly treated. It is entirely preventable, however, and treatment can be started early to minimise the damage to the heart valves.

The main prevention of rheumatic heart disease is ensuring that a person with a history of strep throat or rheumatic fever gets antibiotics immediately.

Other ways to prevent rheumatic heart disease include getting regular check-ups with your doctor and taking any medications as a doctor recommends. Doctors may also suggest certain lifestyle changes to improve the patient's health such as eating a nutritious diet and getting plenty of exercise can help reduce the risk of complications from rheumatic heart disease.

When to Consult a Doctor

You can also get in touch with the expert cardiology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.

Conclusion

Rheumatic heart disease can happen to any person, but it is most common in children and teenagers with untreated or under-treated strep infections. Depending on the damage to the heart valve, doctors may recommend different treatment options to repair a damaged valve.

FAQs About Rheumatic Heart Disease

Q. What is the main cause of rheumatic heart disease? A. Streptococcus pyogenes (group A streptococcus) is the main cause of rheumatic heart disease. It also spreads from person to person through the air, much like a common cold or the flu.

Q. Is rheumatic heart disease serious? A. Rheumatic heart disease can develop if rheumatic fever is not treated quickly. The valves that separate the heart's chambers might become damaged from rheumatic fever. Rheumatic heart disease can be fatal or necessitate open heart surgery if left untreated.

Q. What are the complications of rheumatic heart disease? A. Complications from rheumatic heart disease can include heart failure caused by a severely narrowed or leaking heart valve and bacterial endocarditis, an infection of the heart's inner lining. In addition, women with rheumatic heart disease are at an increased risk of developing complications during pregnancy and delivery.

Q. What are the risk factors for rheumatic heart disease? A. Several risk factors include -

Environmental factors
Family medical history
Type of bacterial infection
Overcrowding and a lack of access to medical treatment are all factors that contribute to increased risk.

References

- https://www.narayanahealth.org/specialities/rheumatology
- https://www.healthline.com/health/rheumatic-fever#diagnosis