Unveiling the Causes of Rheumatic Heart Disease: Understanding its Origins

Rheumatic heart disease (RHD) is the sole preventable heart vessel condition that is associated with significant disabilities and fatalities. It is the most common acquired heart disease in individuals less than 25 years of age. It has been reported that the incidence of rheumatic heart disease in India is between 0·12–4·54 per 1000 children aged 5–15 years. Over 288 to 348 people die of rheumatic heart disease every year. In nations where RHD is widespread, it accounts for 15–20% of heart failure patients. This disease can be prevented by taking steps to avoid exposure to streptococcal infections or treating the disease with antibiotics.

This disease is the result of heart valve damage caused by an abnormal immune response to a specific bacteria (Streptococcus pyogenes infection). Early clinical diagnosis is critical for its successful treatment. While severe disease is managed with medication, interventional therapy, and surgery. A comprehensive clinical and echocardiographic examination is the cornerstone of managing this disease.

Although it is challenging to anticipate RHD to be completely eradicated in the next several decades, the disease burden could be lowered to levels observed in high-income nations through the implementation of prevention and treatment initiatives. To prevent rheumatic heart disease, it's critical to understand its causes. In the article that follows, we will learn more about the causes of rheumatic heart disease.

What is Rheumatic Heart Disease?

Rheumatic heart disease is damage of heart valves due to rheumatic fever. The causative agent behind rheumatic fever is the bacterial infections (group A streptococcal (GAS) infections). The body’s immune response, triggered either due to strep throat or scarlet fever, results in inflammation throughout the body, including in the heart. If left untreated, the inflammation may cause major health issues and irreversible damage to the heart valves.

What are the Signs & Symptoms of Rheumatic Heart Disease?

Years may pass after a strep infection or rheumatic fever before rheumatic heart disease symptoms manifest. RHD patients may encounter:

• Fatigue
• Chest pain
• Shortness of breath
• Heart murmur.
• Abdominal swelling
• Swelling in hands and/or feet

What are Rheumatic Heart Disease Causes?

Rheumatic fever, an inflammatory condition that can affect many connective tissues, particularly in the brain, joints, skin, and heart, is the primary cause of rheumatic heart disease. Over time, the heart valves may become inflamed and scarred. This may lead to the heart valve narrowing or leaking, which would make it more difficult for the heart to pump blood normally. Heart failure may arise from this, which could take years to develop.

Risk Factors of Rheumatic Heart Disease

An increased risk of RHD exists in those who:

• lack access to medical care and medicines like antibiotics

• have recurrent and neglected strep infections

• live in unhealthy or congested environments

When to Consult Your Doctor?

If you notice any new or worsening symptoms, get in touch with your doctor. These symptoms include:

• Confusion
• Troubled breathing
• Pain in the chest
• Discomfort or swelling in your lower body

How is Rheumatic Heart Disease Diagnosis Done?

People who have rheumatic heart disease are likely to have had a strep infection recently. To check for strep, a blood test or throat culture may be performed. The following tests may be performed in addition to a thorough medical history and physical examination to diagnose rheumatic heart disease:

1. Echocardiogram (echo)
2. Electrocardiogram (ECG)
3. Chest X-ray
4. Cardiac MRI
5. Blood tests (for testing ESR and CRP levels)

Rheumatic Heart Disease Treatment Options

The rheumatic heart disease has no known treatment. However, treatment may stop the progression of the illness and help you manage your symptoms. Following are the treatment options:

1. Medical Intervention: To treat an irregular heartbeat, your doctor might advise taking medication. Blood thinners, or anticoagulants, can lower the risk of stroke and blood clots.
    
2. Surgical Intervention: Heart valve surgery may be necessary to treat severe rheumatic heart disease and restore the heart valve normal functions. Damaged heart valves are replaced or repaired by a surgeon.

How to Prevent Rheumatic Heart Disease?

When a streptococcal infection first appears, taking antibiotics can help prevent rheumatic heart disease. Consult a doctor if you or your child suffers from:

• High Fever
• Chorea (jerky, uncontrollable muscles movements).
• Unusual Joint Pains
• Muscular pain.
• Sore throat
• Tonsillitis (swelling in tonsils)

Conclusion

Heart valve inflammation and associated damage is the main cause of rheumatic heart disease. The body's immune system responds to an untreated bacterial infection by causing widespread inflammation in the body. It ruins your heart valves and interferes with blood flow over time. Failure of the heart may occur from rheumatic heart disease if not treated or managed timely. Careful observation and treatment are necessary for those who have the medical condition.
 
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FAQs

Q1: How long can you live with rheumatic heart disease?
A: One can have good recovery from rheumatic heart disease upon early diagnosis and timely therapeutic interventions. However, the prognosis is poor for young individuals having severe RHD at the time of diagnosis.

Q2: Which heart valve is rheumatic fever prone to damage?
A: Any heart valve can be impacted by rheumatic fever, but the mitral valve, which lies between the left side of the heart's two chambers, is the most frequently affected.

Q3: How long does the RHD treatment take?
A: Treatments typically last between five and ten years, or until the patient turns twenty-one. Even after surgery, treatment for severe chronic RHD may last a lifetime.

Q4: Who is most vulnerable to developing rheumatic heart disease?
A: A person is more vulnerable if they have a strep infection and do not receive proper treatment. The greatest risk factor for rheumatic fever and rheumatic heart disease in children is recurrent strep throat infections. The diagnosis of rheumatic heart disease requires a recent history of strep infection or rheumatic fever.

Q5: Which surgical intervention is done for RHD?
A: The options include closed mitral valvotomy, mitral valve repair, or autograft, bioprosthetic, or mechanical valve replacement. Treatment for aortic valve disease typically involves replacing or repairing the valve with a mechanical, homograft, or pulmonary autograft valve.

Q6: How is rheumatic heart disease diagnosis done from blood tests?
A: The blood examinations are the mainstay of rheumatic fever diagnosis as it can help in knowing whether there is any inflammation in the body. These assays include the erythrocyte sedimentation rate (ESR), commonly referred to as the sed rate, and C-reactive protein (CRP) analysis.

Q7: What antibiotics are used to treat RHD?
A: Benzathine benzylpenicillin G (deep intramuscular injection), Phenoxymethylpenicillin/ penicillin V (orally), and/or erythromycin (orally) are the antibiotics that are used to treat RHD.