Summary about Disease
Rheumatic heart disease (RHD) is a chronic heart condition resulting from rheumatic fever, an inflammatory disease that can develop following inadequately treated strep throat or scarlet fever. Rheumatic fever can damage the heart valves, leading to RHD, which can cause significant morbidity and mortality. The damage to the heart valves restricts blood flow, forcing the heart to work harder.
Symptoms
Symptoms of RHD can vary depending on the severity of the valve damage. Common symptoms include:
Shortness of breath, especially during exertion or when lying down.
Chest pain.
Fatigue.
Swelling of the ankles or feet (edema).
Heart palpitations (irregular heartbeats).
Heart murmur (an abnormal sound heard with a stethoscope).
Dizziness or fainting.
Causes
RHD is caused by rheumatic fever, which is a complication of untreated or inadequately treated strep throat or scarlet fever (caused by Streptococcus pyogenes bacteria). The body's immune system attacks the bacteria, but the immune response can also mistakenly target the heart valves, joints, brain, and skin, leading to inflammation and damage.
Medicine Used
Treatment for RHD focuses on managing symptoms, preventing complications, and preventing recurrence of rheumatic fever. Medications used include:
Antibiotics: To treat active strep infections and prevent future infections (prophylactic antibiotics). Penicillin is commonly used.
Anti-inflammatory medications: To reduce inflammation and pain. Aspirin, corticosteroids, or NSAIDs may be prescribed.
Diuretics: To reduce fluid buildup in the body (edema).
Medications to control heart rhythm: Such as beta-blockers or antiarrhythmics, to manage irregular heartbeats.
ACE inhibitors or ARBs: To lower blood pressure and reduce the workload on the heart.
Anticoagulants: To prevent blood clots, especially if atrial fibrillation is present.
Valve repair or replacement: Surgery may be necessary in severe cases of valve damage.
Is Communicable
Rheumatic heart disease itself is not communicable. It is a complication of rheumatic fever, which is caused by a bacterial infection (strep throat or scarlet fever). While the strep infection is contagious, RHD is the result of the body's reaction to the infection, not the infection itself.
Precautions
Prompt treatment of strep throat: The most important precaution is to ensure that strep throat and scarlet fever are diagnosed and treated promptly with antibiotics.
Prophylactic antibiotics: Individuals who have had rheumatic fever need long-term prophylactic antibiotics (usually penicillin) to prevent recurrent strep infections.
Good hygiene: Frequent handwashing can help prevent the spread of strep infections.
Regular medical checkups: People with RHD should have regular checkups with a cardiologist to monitor their heart condition and adjust treatment as needed.
Dental hygiene: Maintaining good dental hygiene is essential to prevent endocarditis (infection of the heart valves), especially for individuals with damaged heart valves.
How long does an outbreak last?
Rheumatic fever itself can last for several weeks to months. However, the long-term damage to the heart valves (RHD) is a chronic condition that persists for life. Secondary prophylaxis with antibiotics is required, possibly lifelong, to prevent reactivation of acute rheumatic fever.
How is it diagnosed?
Diagnosis of RHD involves:
Medical history and physical exam: The doctor will ask about past history of strep throat, rheumatic fever, and symptoms. A physical exam will include listening to the heart for murmurs.
Echocardiogram: This is the primary diagnostic test. It uses ultrasound to visualize the heart valves and assess their function.
Electrocardiogram (ECG or EKG): This test measures the electrical activity of the heart and can detect arrhythmias or other heart problems.
Chest X-ray: To assess the size and shape of the heart and lungs.
Blood tests: May be done to look for signs of inflammation or infection. The ASO titre confirms a recent strep infection.
Timeline of Symptoms
Strep throat/Scarlet fever: Infection occurs first, with symptoms like sore throat, fever, rash (scarlet fever).
Rheumatic fever: Typically develops 1-5 weeks after untreated or inadequately treated strep throat or scarlet fever. Symptoms can include fever, joint pain, rash, Sydenham's chorea (involuntary movements), and carditis (inflammation of the heart).
Rheumatic heart disease: Damage to the heart valves may not be immediately apparent. It can take years for significant symptoms of RHD to develop, depending on the severity of valve damage. Early symptoms include shortness of breath, fatigue, and heart murmur. Over time, symptoms can worsen and lead to heart failure.
Important Considerations
Prevention is key: Preventing rheumatic fever through prompt treatment of strep throat is the most effective way to prevent RHD.
Long-term management: RHD requires long-term medical management with regular monitoring by a cardiologist.
Risk of endocarditis: People with RHD are at increased risk of endocarditis, so good dental hygiene and prophylactic antibiotics before certain dental or surgical procedures may be recommended.
Pregnancy: Women with RHD require specialized care during pregnancy due to the increased stress on the heart.
Lifelong prophylaxis: Secondary prophylaxis with antibiotics (usually penicillin) is crucial to prevent recurrent strep infections and further damage to the heart valves. The duration of prophylaxis depends on the severity of the RHD and the risk of recurrent infection, but is often lifelong.