What is Rheumatic Heart Disease?

Rheumatic heart disease (RHD) is an acquired disorder that resulted from an inflammatory disease called “rheumatic fever.” This rheumatic heart disease is characterized by permanently damaged heart valves. The heart valve damage may develop right after streptococcal infection such as scarlet fever or strep throat that are not properly or inadequately treated. 

The specific bacteria responsible for strep throat and scarlet fever infections are “Group A Streptococcus.” The immune system responds to scarlet fever or strep throat infection causing a generalized inflammatory condition in the body — the rheumatic fever, which causes progressive damage to the heart valves.

Rheumatic fever is thought to be the cause of the body’s immune system reaction to infection. Rheumatic fever is prevalent in young people under 25 of age. Most often, the disease starts as strep throat in childhood and if not treated early may continue to develop in a more severe heart disorder — the rheumatic heart disease, that may debilitate or even cause a life-threatening condition to the individual.

What is the Cause of Rheumatic Heart Disease?

Rheumatic heart disease is caused by an inflammatory disease — rheumatic fever. Rheumatic fever affects the connective tissues of the heart, brain, skin, and joints. 

This causes the heart valves to be inflamed and scarred over time which may result in the leaking or narrowing of the heart valve making it difficult for the heart to perform its normal pumping function. It takes years to develop this rheumatic fever and this condition may eventually cause heart failure.

Who are at Risk for Rheumatic Heart Disease?

The disease is mostly seen in younger children and adolescents ages 5 to 15 years old. There is an increased risk of rheumatic heart disease for untreated or improperly-treated streptococcal infections. 

Children experiencing recurrent streptococcal throat infections are at the most risk in acquiring the rheumatic fever in which over time may cause rheumatic heart disease.

Rheumatic heart disease is commonly seen in the Middle East, South Pacific, Africa, South and Central Asia, and in other poverty-stricken developed countries but is rarely seen in countries like the United States.

What are the Common Signs and Symptoms of Rheumatic Heart Disease?

A person with a history of rheumatic fever or periodic streptococcal infection serves as a significant point of reference in the diagnosis of rheumatic heart disease. There are varying symptoms of rheumatic fever depending on the severity of the infection. In some cases, symptoms are barely determined due to the mildness of the infection. Typically, symptoms of rheumatic fever will be visible after one to five weeks of streptococcal infection and may likely to disappear after which.

Listed below are the most common symptoms of rheumatic heart disease includes:

  • Fever
  • Shortness of breath
  • Chest pains
  • Fast heartbeat
  • Stomach pains
  • Fatigue
  • Presence of small round nodules under the skin
  • Rash – reddish, raised rash usually seen on the trunk of the body, legs, or arms
  • Uncontrolled, jerky body movements of arms and legs
  • Joint inflammation – tender, swollen, and painful joints most commonly in the ankles, knees, wrists, and elbows. The inflammation transfers from one joint to another over several days.

What are the Common Complications of Rheumatic Heart Disease?

Listed are the commonly observed complications of rheumatic heart disease:

 

  • Heart failure

 

Heart failure is the significant cause of disability and death from rheumatic heart disease due to the scarred and damaged valves of the heart.

 

  • Stroke

 

Persons with rheumatic heart disease are at high risk of ischemic stroke due to blood clots formed in the heart and following a blockage on the blood flow to other parts of the brain.

 

  • Endocarditis

 

Endocarditis is an infection that generally occurs when bacteria, fungi, or other germs from the mouth and other parts of your body, contaminates the bloodstream and adheres to damaged areas of the heart.

 

  • Ruptured heart valve

 

This is the end result of a damaged and scarred heart valve in people contracted with rheumatic heart disease. This is a medical emergency that usually requires urgent surgery to repair or replace the heart valve.

 

  • Arrhythmia

 

Due to a permanent heart valve damage of people with rheumatic heart disease, an increased risk of atrial fibrillation is likely to happen which serves to worsen heart failure causing palpitations and increased shortness of breath.

  • Complications of pregnancy and delivery 

Pregnant women pronounced to have rheumatic heart disease are at high risk of significant illness and even death. Due to the abnormality of the heart, pregnant women may suffer detrimental consequences during pregnancy, labor, or delivery.

How is Rheumatic Heart Disease Diagnosed?

People who have the history of strep infection or contracted a recent strep infection would have to be subjected to the following screening test, that includes:

  • A throat culture — to determine the presence of Group A Strep.
  • Auscultation — this is done during the routine physical examination to listen to the heart’s murmur sound.
  • Blood tests — particularly the Antistreptolysin-O (ASO), these tests may be used to look for certain infections and inflammation.
  • Echocardiogram (echo) — this test uses sound waves to check the chambers and valves of the heart.  This is the most useful test for diagnosing heart valve problems.
  • Electrocardiogram (ECG) — this test records the timing and strength of the electrical activity of the heart. It can determine abnormal rhythms (dysrhythmias or arrhythmias) and can also spot heart muscle damage. 
  • Cardiac Magnetic Resonance Imaging — an imaging test that can show precise details of the heart valves and heart muscle.
  • Chest X-ray — this imaging is done to check the lungs and heart if it’s enlarged.

Is Rheumatic Heart Disease Treatable?

Prevention” is the best key to treat rheumatic heart disease. Eradication of the causative agent, Group A Streptococcus bacteria through the use of antibiotics can cure the strep throat and prevents rheumatic fever from further developing.

Rheumatic heart disease is a preventable and treatable type of cardiovascular disease but ironic devastating statistics show that over 32 million people around the world are affected by rheumatic heart disease and have claimed 275,000 lives annually.

Cite this article as:
Editorial Staff, "THE RHEUMATIC HEART DISEASE – A PREVENTABLE TYPE OF HEART DISEASE," in Medicalopedia, June 18, 2020, [Permalink: https://www.medicalopedia.org/8985/the-rheumatic-heart-disease-a-preventable-type-of-heart-disease/].