Indian study shows cardiac drug ‘Flecainide’ may help rheumatic heart disease patients, wins excellence award

Chest pain or discomfort is one of the first noticeable symptoms of rheumatic heart disease .

India has a high burden of rheumatic heart disease often affecting young people in their prime and productive phase of life. Scientists at the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) cardiology department have some good news for those afflicted with the disease.

Rheumatic heart disease (RHD) Is the most common heart disease among young people under the age of 25. It claims over 291,000 lives annually worldwide, majorly in the low- or middle-income countries, according to the World Health Organisation (WHO).

The disease results from damage to heart valves caused by rheumatic fever. Unfortunately, there is no cure for the condition, which can lead to heart valve damage, stroke, heart failure, and death, if left untreated. Treatment of severe rheumatic heart disease often requires costly surgery that is usually not available in low-income countries.

An Indian study has found that a drug called Flecainide is effective in achieving normal cardiac rhythm in patients with rheumatic heart disease, offering new hope to many people suffering from the condition.

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The study undertaken by Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) cardiology department has also won the first prize of excellence in cardiology awarded by the AV Gandhi Society of Cardiac Angiography and Interventions (SCAI).

According to Prof. Aditya Kapoor of the department, who mentored the work, Flecainide has been used to treat certain types of abnormal heart rhythms by blocking abnormal electrical signals in the heart, but it was never used in patients with RHD due to fears of cardiac toxicity.

They studied the role of the drug in 50 RHD patients and found it helped achieved normal cardiac rhythm in nearly 75 per cent cases without any untoward side effects.

Drugs currently used for control of chaotic heart rhythms called atrial fibrillation (AF) in RHD patients often cause a lot of side effects, Prof. Aditya Kapoor added.

Nearly one third of RHD patients have atrial fibrillation, which if uncontrolled, can cause dislodgement of clots from inside the heart to vital body organs leading to stroke and limb gangrene, a condition called thromboembolism, he explained.

India facing high burden of rheumatic heart disease

According to Prof. Kapoor, India has a very high burden of rheumatic heart disease often affecting young people in their prime and productive phase of life.

The estimated average prevalence of rheumatic heart disease in India is 0.5/1000 children in age group of 5 -15 years, said a research paper published in the Indian Heart Journal in January 2019. The disease affects almost 44,000 RHD patients every year and the expected mortality is 1.5 per cent -3.3 per cent per year, as per the study titled "Current status of rheumatic heart disease".

However, the study also noted that the country's burden may be more than this as no data are available from large populous, underdeveloped states such Bihar and Jharkhand.

As 65 percent of India's population is younger than 35 years and RHD affects the young population, it is an important cause of disease burden in India, the authors pointed out.

The potential and productivity of the country are affected adversely due to the disease burden. Therefore, it is imperative that India invest in prevention and control of Rheumatic fever (RF)/rheumatic heart disease (RHD), the authors concluded.

Rheumatic heart disease: Causes and prevention

Rheumatic heart disease starts as a sore throat caused by a bacterium called Streptococcus pyogenes that is most common in childhood. Like other upper respiratory tract infections, strep throat can easily transmit from person to person.

Repeated strep infections can lead to rheumatic fever which occurs when the immune system reacts against the body tissues. Rheumatic fever is characterised by the inflammation and scarring of heart valves, which eventually result in rheumatic heart disease. If left untreated, RHD may progress to serious heart damage.

RHD patients may not have any obvious symptoms in the early stages. Early signs of rheumatic heart disease may include:

  • heart murmurs (which may be heard through a stethoscope)
  • changes in the way heart valves work (seen on heart scan or echocardiography).

The first noticeable symptoms of rheumatic heart disease usually result from heart failure or heart valve damage. These may include:

  • chest pain or discomfort
  • shortness of breath (which may get worse when exercising or when lying down)
  • swelling of the stomach, hands or feet
  • fatigue
  • rapid or irregular heartbeat

RHD is a preventable disease. Promptly treating strep throat infection with appropriate antibiotics is the only way to prevent rheumatic fever, which can cause permanent damage to the heart (rheumatic heart disease). Benzathine penicillin G is the most commonly used antibiotic in preventing further streptococcal infection and damage to heart valves. It is given by intramuscular injection every 3-4 weeks over many years.

It is a key priority of the WHO to ensure a steady, quality supply of benzathine penicillin to prevent rheumatic heart disease and rheumatic fever.

When to see a doctor

Take your child to a doctor if he/she shows possible signs or symptoms of strep throat, which include pain when swallowing, fever, headache, stomach pain, nausea and vomiting.

Repeated episodes of strep throat that are untreated or not treated completely can lead to rheumatic fever. Watch out for the symptoms of rheumatic fever in your child such as:

  • Fever
  • Painful joints most often in the knees, ankles, elbows and wrists
  • Pain that migrates from one joint to another
  • Red, hot or swollen joints
  • Painless nodules under the skin near joints and/or a rash consisting of pink rings with a clear centre (both rare)
  • Fatigue
  • Heart murmur
  • Chest pain
  • Jerky, uncontrollable body movements (Sydenham chorea) most often in the hands, feet and face
  • Outbursts of unusual behaviour, such as crying or inappropriate laughing, that accompanies Sydenham chorea

India needs effective intervention for prevention of RHD

The research paper in the Indian Heart Journal stressed the need for an effective intervention for prevention of rheumatic fever and rheumatic heart disease in India. According to the authors, this could be achieved by

  • Creating enabling environment through policy intervention to promote sanitation, hygiene, better living conditions, nutrition, and access to affordable and quality healthcare equitably.
  • Strengthening of primary health-care services for detection of children with streptococcal pharyngitis.
  • Opportunistic screening for RF/RHD.
  • Implementing evidence-based primary and secondary preventive intervention, etc.

While some people may be genetically disposed to the risk of developing rheumatic fever, environmental factors also play a great role in increasing the risk. Overcrowding, poor sanitation and other conditions that can facilitate rapid transmission or multiple exposures to strep bacteria are other risk factors for rheumatic fever.

Rheumatic heart disease has been eradicated in many parts of the world including Europe and North America. But still it remains prevalent in sub-Saharan Africa, the Middle East, Central and South Asia, the South Pacific, and among immigrants and older adults in high-income countries, especially in indigenous peoples as per WHO.

With inputs from IANS

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