Rheumatic heart disease

Rheumatic heart disease (RHD) is a chronic heart condition caused by rheumatic fever, which is itself a complication of untreated or inadequately treated streptococcal pharyngitis (strep throat) or scarlet fever. Rheumatic fever can cause inflammation in the heart, joints, skin, and brain. When it affects the heart, it can lead to permanent damage to the heart valves, a condition known as rheumatic heart disease.

Pathophysiology

Rheumatic heart disease primarily affects the heart valves. The most commonly affected valve is the mitral valve, followed by the aortic valve. The disease process involves an autoimmune response to the Group A Streptococcus bacteria, which leads to inflammation and scarring of the heart valves. This scarring can cause the valves to either not open fully (stenosis) or not close completely (regurgitation), leading to various complications such as heart failure, atrial fibrillation, and infective endocarditis.

Symptoms

The symptoms of rheumatic heart disease can vary depending on the severity of the valve damage. Common symptoms include:

• Shortness of breath, especially during exertion or when lying down
• Fatigue
• Swelling of the ankles, feet, or abdomen
• Chest pain
• Palpitations
• Fainting or dizziness

Diagnosis

Diagnosis of rheumatic heart disease typically involves a combination of medical history, physical examination, and diagnostic tests. Key diagnostic tools include:

• Echocardiography: To visualize the heart valves and assess their function
• Electrocardiogram (ECG): To detect abnormal heart rhythms
• Chest X-ray: To check for heart enlargement or fluid in the lungs
• Blood tests: To detect markers of inflammation and previous streptococcal infection

Treatment

Treatment of rheumatic heart disease focuses on managing symptoms and preventing further valve damage. Options include:

• Medications: Such as diuretics, beta-blockers, and anticoagulants
• Antibiotic prophylaxis: To prevent recurrent streptococcal infections
• Surgical interventions: Such as valve repair or replacement in severe cases

Prevention

Preventing rheumatic heart disease involves prompt and adequate treatment of streptococcal throat infections with antibiotics. Public health measures, including improving access to healthcare and education about the importance of treating strep throat, are crucial in reducing the incidence of rheumatic fever and subsequent rheumatic heart disease.

Epidemiology

Rheumatic heart disease is more common in developing countries and among populations with limited access to healthcare. It remains a significant cause of morbidity and mortality in these regions. In developed countries, the incidence has decreased significantly due to better healthcare infrastructure and widespread use of antibiotics.

Related Pages

• Rheumatic fever
• Mitral valve
• Aortic valve
• Heart failure
• Atrial fibrillation
• Infective endocarditis
• Streptococcal pharyngitis
• Scarlet fever