Rheumatic Heart Disease

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Rheumatic heart disease is caused by damage to the heart valves and heart muscle from the inflammation and scarring caused by rheumatic fever. The World Health Organization states that globally, almost 2% of deaths from cardiovascular diseases are related to rheumatic heart disease.

Rheumatic fever mostly affects children between the ages of 5 and 15 in developing countries, especially where poverty is widespread. According to the World Heart Federation , the worst affected areas are sub-Saharan Africa, south-central Asia, the Pacific and indigenous populations of Australia and New Zealand. This section outlines more detailed information about rheumatic heart disease, including rheumatic fever.

If you are worried that you or a loved one might have rheumatic heart disease, find out which are the most useful and common tests for diagnosing rheumatic heart disease.

The best way to deal with rheumatic heart disease is through prevention. Aggressive treatment of throat infections caused by group A streptococcus and of rheumatic fever can help to limit rheumatic heart disease.

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Rheumatic Heart Disease does not always cause symptoms. When it does, symptoms might include:

  • Shortness of breath, even when lying down
  • Excessive fatigue
  • Heart palpitations, causing irregular heart beats or fluttering sensation in the heart
  • Chest pain or a thumping sensation in the chest
  • Fainting
  • Breathlessness on exertion
  • Swollen ankles, wrist or stomach

Symptoms of rheumatic fever include:

  • Fever
  • Painful and tender joints, most often the ankles, knees, elbows or wrist
  • Pain in one joint that migrates to another joint
  • Red, hot or swollen joints
  • nausea, stomach cramps and vomiting
  • Small, painless nodules beneath the skin
  • Chest pain and shortness of breath
  • Heart palpitations
  • Fatigue
  • Flat or slightly raised, painless rash with a ragged edge
  • Jerky, uncontrollable body movements, most often in the hands, feet and face
  • Outbursts of unusual behavior, such as crying or inappropriate laughing
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According to the World Heart Federation , rheumatic heart disease is the most common acquired heart disease in children in many countries of the world, especially in developing countries. It is caused by damage to the heart valves and heart muscle from the inflammation and scarring caused by rheumatic fever.  Anyone can get rheumatic fever, but it usually occurs in children between the ages of 5 and 15 years. Approximately 60% of people with rheumatic fever develop some degree of subsequent heart disease.

Every part of the heart, including the outer sac, the inner lining and the valves may be damaged by inflammation caused by rheumatic fever. However, the most common form of rheumatic heart disease affects the heart valves and can lead to crippling valvular heart disease, heart failure and death. It can take several years after an episode of rheumatic fever, however, for valve damage to develop or symptoms to appear.

Rheumatic fever is caused by streptococcal bacteria, which usually begins as a sore throat or tonsillitis in children. Treating strep throat infections with antibiotics can prevent rheumatic fever. In addition, regular antibiotics can prevent those with rheumatic fever from contracting further strep throat infections and causing progression of valve damage.

The decline of rheumatic fever in developed countries is believed to be the result of improved living conditions and availability of antibiotics for treatment of group A streptococcal infection. Overcrowding, poor housing conditions, undernutrition and lack of access to healthcare play a role in the persistence of this disease in developing countries.

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To diagnose rheumatic heart disease, any of the following tests may be conducted:

  • Medical history: Your doctor will study the medical history of you or your child to look for evidence of past attacks of rheumatic fever or strep infection.
  • Physical exam: A physical exam will be conducted, with particular focus on listening to the heart for abnormal rhythms, murmurs or muffled sounds that may indicate inflammation of the heart.
  • Imaging tests: Imaging tests, such as chest x-rays or magnetic resonance imaging (MRI) may be used to look for signs of rheumatic heart disease. A chest x-ray involves taking pictures of your heart or your child’s heart using electromagnetic radiation. This test can reveal enlargement of the heart or fluid in the lungs, which are signs of rheumatic heart disease. An MRI is a process that creates high-quality pictures of the inside of the body, and can show your doctor further detail than an x-ray.
  • Electrocardiogram (ECG): An electrocardiogram records electrical signals as they travel through your heart or child's heart. Your doctor can look for patterns among these signals that indicate inflammation of the heart, abnormal heart rhythm (arrhythmia) or poor heart function.
  • Echocardiography: All patients with murmurs suggestive of valve disease, or a past history of rheumatic fever, require echocardiography.  An echocardiogram uses sound waves to produce live-action images of the heart. This will detect any valvular lesion, and allows for an assessment of its severity. It is the most useful test for finding out if rheumatic heart disease is present.
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The best way to deal with rheumatic heart disease is to prevent it. Aggressive treatment of throat infections caused by group A streptococcus and of rheumatic fever can help to limit rheumatic heart disease. See Prevention for more details.

Once you have been diagnosed with rheumatic heart disease, it is critically important to have regular monitoring of the condition of your heart valves and your heart muscle, usually with periodic physical exams and echocardiograms. Since rheumatic heart disease is usually progressive, the heart valve problems tend to worsen over time. This means that at some point, surgery is likely to be required to repair or replace heart valves in those with severely damaged valves.

The timing of this surgery is extremely important. It is critical to replace the valves before permanent heart muscle damage occurs, but on the other hand it is often not a good idea to replace the valves too early. This is because the artificial valves themselves may deteriorate over a few decades, and additional surgery may become necessary. For this reason, people with rheumatic heart disease should generally be under the watchful eye of an experienced cardiologist.

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As rheumatic heart disease is the most severe complication of rheumatic fever, it is important to try to prevent the initial attack of rheumatic fever. Early treatment of acute throat infections caused by group A streptococcus can stop the development of rheumatic fever. This is achieved by up to 10 days of an oral antibiotic (usually penicillin) or a single intramuscular penicillin injection.

If rheumatic fever does occur, regular long-term antibiotic therapy can prevent repeat attacks of rheumatic fever which can damage the heart further and give rise to rheumatic heart disease. The administration of antibiotics has to be continued for many years, until the person is 20 to 40 years old, depending on the time of the last episode of rheumatic fever and whether they have rheumatic heart disease or not. This can also stop disease progression in people whose heart valves are already damaged by the disease.

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