Rheumatic heart disease

Causes
Risk Factors
Symptoms
Diagnosis
Treatment

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Rheumatic heart disease (RHD) is a type of rare heart disease found in children of age group 5-15 years, which occurs due to the inflammation of heart. This inflammation is caused due to an infection of Streptococcus bacteria that leads to symptoms like sore throat (strep throat) and fever called rheumatic fever.

The problem starts with a person suffering from a condition called rheumatic feveras a child. Since this fever is often very slight it is ignored. The child may subsequently have joint pain and active rheumatic carditis (a condition where the heart is inflamed due to infection). The child may also have shortness of breath and chest pain with high fever. The downside to this disease is that these symptoms are short lived and subside quickly, and since it does not recur it is often ignored. By the time one notices the first symptom of rheumatic fever to the time they notice something gravely wrong and visit a doctor, it is usually quite late and the heart valve is affected. One of the first valves to be affected is the mitral valve. (Read: Rheumatoid Arthritis: Your guide to living with the disease)

Read more about causes, symptoms, diagnosis and treatment of heart disease.

Causes

What happens is that people might suffer from rheumatic fever in childhood, which is due to a streptococcal throat infection.

In a susceptible individual, this throat infection triggers problems which lead to the destruction of their heart valve. This can also affect the kidney where it can cause terminal nephritis. Streptococcal glomerulonephritis, is often not very worrisome. In contrast the heart valve once damaged is very serious as it is very difficult to rectify. Apart from the heart valve, rheumatic fever can also affect the pericardium (outer covering of the heart), myocardium (muscles of the heart) and the valves present in the endocardium. (Read: Have a sore throat? Try these tips!)

Risk Factors

This disease is known all over the world now. Bu it does not happen in the western world, the reason being good hygiene. Streptococcal throat infection is not common there. Even if it does happen it is promptly treated with antibiotics. Another reason for developing countries to have higher incidence of this disease is the overcrowding and endemicity. In India people live in extremely close quarters and the transmission of diseases is very easy.

In India, children living in low socioeconomic conditions usually lack hygiene. They live in close proximity to each other and have lesser access to proper sanitation, reducing their ability to maintain good hygiene. And these are usually the starting points of the disease. (Read: Wash hands the right way; prevent diseases like cholera, typhoid and gastroenteritis)

Symptoms

In adults the most glaring symptom is shortness of breath, also known as exertional dyspnoea (extreme shortness of breath when they perform any activity). He/she will not experience any discomfort when at rest. Only when a patient sees that they are no more able to perform the most basic functions in life do they go to a doctor.

Here, it is important to note that once the problem starts and is diagnosed, it needs treatment right away because the problem starts as an insidious one and worsens over time to such an extent that life becomes unbearable.

Diagnosis

Rheumatic heart disease is diagnosed by performing an echocardiogram or ECG where the functioning of the heart valve is checked. A person will also have to get a blood test called ASO titer. This test checks for the presence of the infection or its progression.

In children one has to also get a urine test to rule out the involvement of the kidneys. A doctor may also require to do some more routine tests for inflammatory markers.

Treatment

If a patient’s heart valve is damaged he/she can either have a valvuloplasty or have a valve replacement. A valvuloplasty is a non surgical technique that is done by cardiac catheterization (just like an angioplasty). It is quite effective and requires the patient to stay in the hospital for a shorter period of time. This procedure is mainly done for a stenosed or narrowed heart valve. In the case of an incompetent valve – a valve that has become floppy – it needs to be replaced by either a porcine valve (from a pig) or with a metallic one. A valve replacement surgery, along with the hospital stay costs anywhere between four to seven lakhs and requires the patient to stay in the hospital – initially in the ICCU and then a normal ward – for about three days to one week.

In the case of an infection a patient will need long term penicillin prophylaxis. This can either be by intravenous or via oral tablets. For acute rheumatic fever the mainstay of treatment is Aspirin. A doctor will prescribe antibiotics, but he/she will mainly prescribe aspirin.

The content has been verified by Dr. Nilesh Gautam, Senior Interventional Cardiologist, Head of Department of Preventive Cardiology and Rehabilitation at the Asian Heart Institute, Mumbai.