Rheumatic Heart Disease

1. What is rheumatic heart disease?

Rheumatic heart disease (RHD) is a serious and potentially life-threatening condition resulting from untreated or inadequately treated streptococcal throat infections, particularly those caused by group A Streptococcus bacteria. RHD primarily affects the heart and its valves and is a long-term complication of untreated streptococcal pharyngitis (strep throat) or scarlet fever.
Rheumatic heart disease was more common in the past but has become less prevalent in many developed countries due to improved access to healthcare and the use of antibiotics to treat streptococcal infections promptly. However, it remains a significant health concern in some low-income and resource-limited regions where access to healthcare is limited and streptococcal infections remain a problem.
Preventing rheumatic heart disease primarily involves promptly treating streptococcal throat infections with antibiotics. Additionally, individuals with a history of RHD or a known risk of recurrent streptococcal infections may receive prophylactic antibiotics to prevent further episodes and complications. Established rheumatic heart disease management may require medications to manage symptoms and, in severe cases, surgical intervention to repair or replace damaged heart valves.

2. Who gets rheumatic heart disease?

Rheumatic heart disease (RHD) is more common in specific populations and regions of the world, and it tends to affect individuals in specific demographic groups. Here are some key factors that contribute to the risk of developing RHD:
RHD most commonly affects children and young adults, typically between the ages of 5 and 15. This is because the autoimmune response triggered by streptococcal infections that lead to RHD tends to occur in this age group.
It’s important to note that RHD is preventable through timely and appropriate medical care. The primary preventive measure is promptly treating streptococcal throat infections with antibiotics. Additionally, individuals with a history of RHD or known risk factors may receive prophylactic antibiotics to prevent recurrent streptococcal infections and the development or progression of RHD.
Efforts to reduce the burden of rheumatic heart disease include improving access to healthcare, especially in regions where it is more common, increasing awareness about the importance of treating streptococcal infections promptly, and providing ongoing medical care for individuals with RHD to manage their condition and prevent complications.

3. How common is rheumatic heart disease?

Rheumatic heart disease (RHD) was once a common and serious health problem worldwide. Still, its prevalence has declined significantly in many developed countries over the past several decades, thanks to improvements in healthcare, increased access to antibiotics, and better control of streptococcal infections. However, RHD continues to be a significant health concern in specific regions and populations, particularly in low- and middle-income countries where access to healthcare resources and preventive measures may be limited.
It’s important to note that accurate and up-to-date prevalence data for RHD may be limited in some regions, and the true extent of the disease may be underestimated due to challenges in diagnosis and reporting.
Efforts to combat RHD include improving access to healthcare, increasing awareness about streptococcal infections and their timely treatment, and implementing preventive measures such as providing prophylactic antibiotics to individuals at risk. These efforts aim to reduce the prevalence and impact of RHD in affected regions.

4. Who is at risk for rheumatic heart disease?

Several factors can increase an individual’s risk of developing rheumatic heart disease (RHD). These risk factors include:

1. Age: RHD most commonly affects children and young adults, typically between the ages of 5 and 15. This is because the autoimmune response triggered by streptococcal infections that lead to RHD tends to occur in this age group.

2. Prior History of Rheumatic Fever: Rheumatic fever is a precursor to RHD, and individuals with one or more episodes of rheumatic fever are at a higher risk of developing RHD.

3. Untreated or Inadequately Treated Strep Throat: RHD often develops as a complication of untreated or inadequately treated streptococcal throat infections, particularly those caused by group A Streptococcus bacteria. Prompt and effective treatment of strep throat with antibiotics can significantly reduce the risk of RHD.

4. Genetic Factors: Some individuals may have a genetic predisposition to an abnormal immune response to streptococcal infections, making them more susceptible to RHD.

5. Living in High-Risk Areas: RHD is more common in low- and middle-income countries, particularly in parts of sub-Saharan Africa, South Asia, the Pacific Islands, and some countries in Latin America. In these regions, access to healthcare, antibiotics, and preventive measures may be limited, increasing the risk of RHD.

It’s important to note that RHD is preventable through timely and appropriate medical care. The primary preventive measure is promptly treating streptococcal throat infections with antibiotics. Additionally, individuals with a history of RHD, prior episodes of rheumatic fever, or known risk factors may receive prophylactic antibiotics to prevent recurrent streptococcal infections and the development or progression of RHD. Public health initiatives to increase awareness, improve access to healthcare, and implement preventive measures are essential in reducing the risk of RHD in high-risk populations and regions.

5. What are the symptoms of rheumatic heart disease?

The symptoms of rheumatic heart disease (RHD) can vary depending on the severity of the condition and which parts of the heart are affected. RHD primarily affects the heart valves, leading to valve dysfunction. Common symptoms of RHD may include:

1. Heart Murmurs

2. Chest Pain

3. Shortness of Breath

4. Fatigue

5. Palpitations

6. Swelling

7. Fainting or Syncope

8. Joint Pain

It’s important to note that the symptoms of RHD can develop gradually over time, and they may not become evident until the condition has progressed significantly. Additionally, the severity of symptoms can vary widely among individuals with RHD.
Rheumatic heart disease requires medical evaluation and management by healthcare professionals, typically cardiologists. Early diagnosis and appropriate treatment are essential to prevent further complications and improve the quality of life for individuals affected by this condition.

6. What causes rheumatic heart disease?

Rheumatic heart disease (RHD) is primarily caused by an abnormal immune response to untreated or inadequately treated streptococcal infections, particularly those caused by group A Streptococcus bacteria. Here’s how the process of RHD development unfolds:

1. Streptococcal Infection: RHD begins with an initial infection, typically a streptococcal throat infection such as strep throat or, less commonly, scarlet fever. Group A Streptococcus bacteria are responsible for these infections.

2. Incomplete Treatment: If the streptococcal infection is not promptly and adequately treated with antibiotics (such as penicillin), the bacteria can persist in the body even after the symptoms of the infection have resolved. Inadequate treatment can allow the bacteria to continue to cause damage.

3. Autoimmune Response: In some individuals, the immune system’s response to the streptococcal infection is abnormal. Instead of effectively clearing the bacteria from the body, the immune system generates antibodies that cross-react with specific proteins found in the heart, specifically in the heart valves.

4. Valve Damage: Over time, repeated episodes of streptococcal infection and the autoimmune response can lead to inflammation and damage to the heart valves, particularly the mitral and aortic valves. This can result in scarring, thickening, and deformation of the valve tissue.

5. Valve Dysfunction: As the valve damage progresses, the affected valves may not function properly. This can lead to problems such as valve regurgitation (leaking) or valve stenosis (narrowing), reducing the heart’s ability to pump blood effectively.

It’s important to note that not everyone who has a streptococcal infection will develop RHD. The development of RHD involves a combination of genetic predisposition and specific factors related to the individual’s immune response to the infection.
Rheumatic heart disease can have serious and long-lasting consequences, affecting the structure and function of the heart valves. While it is preventable, it remains a significant health concern in regions where access to healthcare and antibiotics may be limited and streptococcal infections continue. The key to preventing RHD is promptly and appropriately treating streptococcal infections with antibiotics, particularly in individuals at risk of developing this condition.

7. How is rheumatic heart disease diagnosed?

The diagnosis of rheumatic heart disease (RHD) involves a combination of clinical evaluation, medical history, physical examination, and various diagnostic tests. Here are the steps typically involved in diagnosing RHD:

1. Laboratory Tests: Blood tests may be ordered to check for signs of inflammation and infection and assess kidney and liver function. These tests can help confirm the presence of an ongoing inflammatory response and may provide additional information about the patient’s overall health.

2. Electrocardiogram (ECG or EKG): An ECG records the heart’s electrical activity and can help identify abnormalities in heart rhythm and the conduction system. While an ECG may not provide a definitive diagnosis of RHD, it can indicate heart abnormalities that warrant further evaluation.

3. Chest X-ray: A chest X-ray can provide images of the heart and lungs, helping to identify any signs of heart enlargement, fluid accumulation, or lung congestion, which may be associated with RHD.

4. Echocardiogram (Echo): An echocardiogram is a critical diagnostic tool for RHD. It uses sound waves to create detailed images of the heart’s structure and function. An echo can reveal abnormalities in the heart valves, such as valve regurgitation or stenosis, and assess the degree of valve damage and dysfunction.

5. Cardiac Catheterization: In some cases, a cardiac catheterization may be recommended to obtain more detailed information about the coronary arteries and the extent of damage to the heart valves. This invasive procedure involves threading a thin tube (catheter) through the blood vessels to the heart.

6. Other Imaging Tests: Depending on the clinical presentation and findings, additional imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans may assess the heart and blood vessels.

The diagnosis of RHD is based on a combination of clinical findings, imaging studies (especially echocardiography), and a history of previous streptococcal infections or rheumatic fever. A cardiologist or pediatric cardiologist typically leads the diagnostic process and determines the severity and extent of the disease.
Early diagnosis and appropriate management are crucial for individuals with RHD to prevent further valve damage and complications. Treatment options may include medications to manage symptoms and prevent complications and, in some cases, surgical intervention to repair or replace damaged heart valves.

8. How is rheumatic heart disease treated?

The treatment of rheumatic heart disease (RHD) aims to manage symptoms, prevent further damage to the heart valves, and reduce the risk of complications. The specific treatment approach can vary depending on the severity of the disease and the individual patient’s condition. Here are some common treatment strategies for RHD:

1. Medications:

– Antibiotics: Individuals with RHD are regularly prescribed antibiotics (usually penicillin or other suitable antibiotics) to prevent recurrent streptococcal infections, as these infections can exacerbate RHD.

– Anti-inflammatory Medications: In some cases, anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids may be prescribed to reduce inflammation and symptoms during acute RHD or rheumatic fever episodes.

2. Symptomatic Management:

– Medications like diuretics may be used to manage fluid retention and reduce swelling (oedema).

– Inotropic medications may be prescribed to improve the heart’s pumping ability in cases of heart failure.

3. Surgical Interventions:

– Valve Repair or Replacement: Surgical intervention may be necessary for individuals with severely damaged heart valves. This can involve repairing or replacing the damaged valve with an artificial one. The choice of procedure depends on the extent of valve damage and other factors.

– Balloon Valvuloplasty: In some cases, a less invasive procedure called balloon valvuloplasty may open narrowed heart valves by inflating a balloon in the valve area. This procedure can be beneficial for individuals with mitral stenosis.

Individuals with RHD must receive ongoing medical care and adhere to the recommended treatment plan to manage their condition effectively and prevent complications. Early diagnosis and appropriate medical management can improve the quality of life for individuals with RHD and reduce the risk of complications such as heart failure, stroke, and infective endocarditis.

9. How is heart valve repair performed?

Heart valve repair is a surgical procedure to treat heart valve diseases, such as valve regurgitation (leaking) or valve stenosis (narrowing). The goal of heart valve repair is to restore proper valve function and improve blood flow without replacing the valve with an artificial one. Repairing a heart valve is typically preferred, as it can preserve the patient’s valve and often leads to better long-term outcomes than valve replacement. Here is an overview of how heart valve repair is performed:

– The process begins with a thorough cardiologist and cardiac surgeon evaluation. Diagnostic tests, including echocardiography (ultrasound of the heart), are used to assess the valve disease’s severity, the valve’s anatomy, and its suitability for repair.

– The patient is placed under general anaesthesia, which ensures they are unconscious and pain-free during the surgery.

– In most cases, heart valve repair is performed through open-heart surgery, which involves creating a median sternotomy (an incision through the breastbone) or a minimally invasive approach (smaller incisions) to access the heart. The choice of approach depends on the specific patient and the type of valve repair needed.

– During open-heart surgery, the patient is connected to a heart-lung machine (CPB machine), which takes over blood pumping and oxygenating it while the heart is temporarily stopped. This allows the surgeon to work on the heart without requiring continuous circulation.

– The surgeon inspects the affected heart valve(s) and performs the necessary repairs, which can vary depending on the type of valve disease:

– For valve regurgitation, repairs may involve resizing or reshaping the valve leaflets, repairing torn or elongated chordae tendineae (the strings that anchor the valve leaflets), or reinforcing the valve annulus (the ring-shaped structure supporting the valve).

– For valve stenosis, procedures such as balloon valvuloplasty (inflating a balloon to stretch the valve) or cutting away excess tissue (valvotomy) may be performed.

– After the repair, the surgeon evaluates the valve function using various techniques, including echocardiography, to ensure that the valve works correctly.

– The heart is gradually warmed and weaned off the heart-lung machine, allowing it to resume its normal function.

– The chest incision is closed with sutures or staples, and the wound is typically covered with sterile dressings.

– The patient is transferred to the intensive care unit (ICU) for close monitoring during the immediate postoperative period. Recovery typically involves several days in the hospital, rehabilitation, and outpatient care.

Heart valve repair is a complex procedure that requires the expertise of a cardiac surgeon and a specialized healthcare team. The specific technique used for repair depends on the patient’s condition and the nature of the valve disease. Successful valve repair can improve quality of life and long-term outcomes for individuals with heart valve disorders.

10. How is heart valve replacement performed?

Heart valve replacement is a surgical procedure used to treat heart valve diseases when the valve is severely damaged and cannot be effectively repaired. During a valve replacement surgery, the diseased valve is removed and replaced with an artificial (prosthetic) valve. Here is an overview of how heart valve replacement is typically performed:

1. Preoperative Evaluation:

– Before the surgery, the patient undergoes a thorough cardiologist and cardiac surgeon evaluation. Diagnostic tests, including echocardiography (ultrasound of the heart), help assess the severity of the valve disease and determine the need for replacement.

2. Anesthesia:

– The patient is placed under general anaesthesia to ensure they are unconscious and pain-free during the surgery.

3. Access to the Heart:

– Heart valve replacement can be performed using different surgical approaches:

– Median Sternotomy: In most cases, a median sternotomy is used, which involves making a vertical incision through the breastbone (sternum) to access the heart. This approach provides full access to the heart and is commonly used for valve replacement.

– Minimally Invasive: In some cases, minimally invasive techniques may be employed, involving smaller incisions and specialized instruments. Minimally invasive approaches are reserved for select patients and specific valve replacement procedures.

4. Cardiopulmonary Bypass (CPB):

– During open-heart surgery, the patient is connected to a heart-lung (CPB) machine. The machine takes over blood pumping and oxygenating it while the heart is temporarily stopped. This allows the surgeon to work on the heart without requiring continuous circulation.

5. Removal of the Diseased Valve:

– The surgeon carefully removes the damaged or diseased heart valve. The type of valve replacement (aortic, mitral, tricuspid, or pulmonary) depends on which valve is affected.

– The removal may involve detaching the valve leaflets and removing the valve annulus (the ring-shaped structure supporting the valve).

6. Implantation of the Prosthetic Valve:

– The new prosthetic valve is selected based on the patient’s condition and the surgeon’s judgment. There are two main types of prosthetic valves:

– Mechanical Valves: These are made of metal and plastic and are very durable. However, individuals with mechanical valves require lifelong anticoagulant (blood-thinning) medication to prevent blood clots.

– Biological Valves: Also known as tissue valves, these are typically made from animal tissues (e.g., pig or cow) or human donor tissue. They do not require long-term anticoagulation but may have a limited lifespan.

7. Suturing and Closure:

– The new prosthetic valve is securely sutured or attached in place within the heart.

– The heart is gradually warmed and weaned off the heart-lung machine, allowing it to resume its normal function.

– The chest incision is closed with sutures or staples, and the wound is typically covered with sterile dressings.

Heart valve replacement is a complex procedure that requires the expertise of a cardiac surgeon and a specialized healthcare team. The choice of valve type (mechanical or biological) and surgical approach depends on the patient’s age, overall health, valve condition, and individual preferences. Successful valve replacement can significantly improve the quality of life for individuals with severe heart valve diseases.

11. How can I prevent rheumatic heart disease?

Preventing rheumatic heart disease (RHD) primarily involves preventing streptococcal throat infections and promptly treating them with antibiotics when they occur. Here are key strategies to avoid RHD:
If you or someone you know develops streptococcal pharyngitis (strep throat) symptoms, such as sore throat, fever, and difficulty swallowing, seek medical attention promptly. Strep throat is typically treated with antibiotics, such as penicillin or amoxicillin. Before completing the entire course, ensure that the prescribed antibiotics are taken as directed, even if symptoms improve.
If you or a family member develop symptoms of rheumatic fever, such as joint pain, skin rash, or chest pain, seek immediate medical attention. Rheumatic fever can be a precursor to RHD, and early diagnosis and treatment are crucial.
Preventing RHD requires individual efforts, community education, and healthcare infrastructure. Timely and appropriate management of streptococcal infections and early diagnosis and treatment of rheumatic fever are critical components of RHD prevention. If you or someone you know is at risk for RHD, consult with a healthcare provider to discuss preventive measures and strategies specific to your situation.

12. What is the outlook for people who have rheumatic heart disease?

The outlook for individuals with rheumatic heart disease (RHD) varies depending on several factors, including the severity of the disease, the extent of heart valve damage, access to medical care, and adherence to treatment and preventive measures.
It’s important to note that RHD is a preventable condition through timely and appropriate medical care. Early diagnosis, adherence to treatment, and lifestyle management are critical components of improving the outlook for individuals with RHD. Each case is unique, and the prognosis should be discussed with a healthcare provider who can provide personalized guidance and treatment recommendations based on the individual’s specific condition and needs.

13. What are the complications of rheumatic heart disease?

Rheumatic heart disease (RHD) can lead to complications, especially when the condition is severe or left untreated. These complications can affect the heart and other parts of the body. Here are some of the common complications associated with RHD:

1. Valve Dysfunction

2. Heart Failure

3. Atrial Fibrillation

4. Infective Endocarditis

5. Stroke

6. Pulmonary Hypertension

7. Chest Pain

8. Joint Problems

9. Reduced Exercise Tolerance

10. Complications During Pregnancy

It’s important to note that the severity and type of complications can vary widely among individuals with RHD. Early diagnosis, appropriate treatment, and adherence to preventive measures are crucial in minimizing the risk of complications and improving the long-term outlook for individuals with this condition. Regular follow-up care with a healthcare provider or cardiologist is essential for managing RHD and addressing emerging difficulties.

14. When should I call the doctor?

It’s essential to call your doctor or seek medical attention promptly in various situations, especially if you have a medical condition or are experiencing symptoms that may indicate a health concern. Here are some general guidelines for when to call your doctor:
If you or someone else is experiencing severe or life-threatening symptoms, such as chest pain, difficulty breathing, sudden weakness or numbness on one side of the body, severe allergic reactions (e.g., difficulty breathing, swelling of the face or throat), or loss of consciousness, call your local emergency number immediately.
Remember that timely communication with your healthcare provider can improve health outcomes and early intervention when necessary. It’s always better to err on the side of caution and seek medical advice when you have concerns about your health. If you need help deciding whether to call your doctor, feel free to contact their office or a medical advice line for guidance.

Rheumatic Heart Disease