Rheumatic Heart Disease: Early Detection, Treatment, and Prevention

Rheumatic heart disease (RHD) is a serious condition caused by heart valve and muscle damage from rheumatic fever, a complication of untreated strep throat or scarlet fever. It primarily affects low- and middle-income countries. Early detection and management are vital, making it essential to understand RHD's symptoms, causes, and risk factors. This article covers RHD's prevalence, signs, diagnostic methods, treatments, and prevention strategies, helping readers recognise warning signs and take proactive steps to safeguard heart health. 

What is rheumatic heart disease? 

Rheumatic heart disease (RHD) results from heart valve and muscle damage caused by rheumatic fever, an inflammatory reaction to untreated group A streptococci infection. This damage leads to valve leakage, narrowing, or scarring, impairing proper function. Over time, the valves can become stiff and deformed, worsening heart performance. If untreated, RHD may progress to severe heart failure and premature death, highlighting the importance of early diagnosis and treatment of streptococcal infections to prevent complications. 

How common is rheumatic heart disease? 

Rheumatic heart disease (RHD) affects 40 million people, mostly under 25, and causes over 300,000 annual deaths, primarily in low- and middle-income countries. Marginalised groups, including indigenous populations, face the highest burden. Most patients die before 40 due to severe complications and limited care. Urgent action is needed for awareness, early detection, and better management to improve outcomes and save lives. 

What are the symptoms of rheumatic heart disease? 

The symptoms of rheumatic heart disease can vary and may not appear until 10 to 20 years after the initial rheumatic fever episode. Common symptoms: 

• Chest pain 

• Excessive fatigue 

• Heart palpitations 

• Shortness of breath 

• Swollen ankles, wrists, or stomach 

• Other signs: 

• Rapid heart rate 

• Fever 

• Involuntary limb movements 

• Rash 

• Severity varies by heart damage. 

What causes rheumatic heart disease?  

Rheumatic heart disease is caused by rheumatic fever, an inflammatory response to an infection with group A streptococci, typically following untreated strep throat or scarlet fever. Repeated episodes of rheumatic fever can lead to progressive scarring and damage to the heart valves. 

Is rheumatic heart disease contagious?  

While rheumatic heart disease itself is not contagious, the underlying cause, strep throat, is highly contagious and can be spread through close contact with an infected individual. The transmission of strep throat is similar to other upper respiratory tract infections, emphasising the importance of prompt treatment to prevent the development of rheumatic fever and subsequent RHD. 

What are the risk factors for rheumatic heart disease? 

Several factors can increase the risk of developing rheumatic heart disease, including: 

1. Living in low- and middle-income countries 
2. Being part of marginalized communities, such as indigenous populations, even in high-income countries 
3. Experiencing repeated streptococcal infections 
4. Age: Children between 5 and 15 years old are particularly vulnerable to rheumatic fever and RHD 

What are the complications of rheumatic heart disease?  

Rheumatic heart disease can lead to severe complications if left untreated or poorly managed. These complications include: 

1. Heart failure: As the heart valves become damaged and unable to function properly, the heart struggles to pump blood effectively, leading to heart failure. 
2. Valvular stenosis or regurgitation: Scarring and deformity of the heart valves can cause them to narrow (stenosis) or leak (regurgitation), compromising blood flow and putting additional strain on the heart. 
3. Increased risk of cardiac complications during pregnancy: Women with RHD face a higher risk of complications such as heart failure, arrhythmias, and even death during pregnancy and childbirth. 
4. Formation of Aschoff nodules and MacCallum plaques: These characteristic lesions in the heart muscle and valves, respectively, indicate ongoing inflammation and scarring. 

Untreated RHD can result in severe disability and premature death, highlighting the critical importance of early detection and appropriate management. 

How is rheumatic heart disease diagnosed?  

Diagnosing rheumatic heart disease involves a comprehensive evaluation of the patient's medical history, including any recent streptococcal infections or rheumatic fever episodes, and a thorough physical examination. The presence of characteristic symptoms and signs, such as joint pain, rash, and heart murmurs, is crucial for accurate diagnosis. 

What tests will be done to diagnose rheumatic heart disease?  

To confirm the diagnosis of rheumatic heart disease and assess the extent of heart damage, several tests may be performed: 

1. Echocardiography: Uses sound waves for detailed heart images; evaluates valve structure and function. 
2. Electrocardiogram (ECG): Records the heart's electrical activity; detects abnormal rhythms and strain. 
3. Blood tests: Identifies streptococcal infections or inflammation, indicating rheumatic fever. 

How is rheumatic heart disease treated? 

Treatment for rheumatic heart disease focuses on managing symptoms, preventing further damage, and addressing any underlying streptococcal infections. The approach may include: 

1. Antibiotics: To treat any active streptococcal infections and prevent recurrent episodes of rheumatic fever. 
2. Anti-inflammatory medications: To reduce inflammation and relieve symptoms such as joint pain and swelling. 
3. Heart failure medications: To help manage symptoms and improve heart function in patients with heart failure. 
4. Surgery: In severe cases, surgery may be necessary to repair or replace damaged heart valves. 

Regular follow-up with a healthcare provider is essential to monitor the condition and adjust treatment as needed. Patients with RHD may also require lifestyle modifications, such as limiting physical activity and adhering to a heart-healthy diet, to manage their symptoms and protect their heart health. 

Can rheumatic heart disease be prevented?  

Yes, rheumatic heart disease can be effectively prevented by promptly and adequately treating streptococcal infections, particularly strep throat. Penicillin is the primary antibiotic used to treat strep throat and prevent the development of rheumatic fever. For individuals who have already experienced rheumatic fever, secondary prophylaxis with antibiotics can help prevent recurrent episodes and further damage to the heart. Ensuring access to timely diagnosis and appropriate treatment, especially in high-risk populations, is crucial in reducing the global burden of RHD. 

What is the outlook for rheumatic heart disease? 

The outlook for patients with rheumatic heart disease depends on the severity of heart damage and the effectiveness of treatment. Early detection and appropriate management can significantly improve outcomes and quality of life. However, if RHD is left untreated or poorly controlled, it can progress to severe heart failure and premature death. Unfortunately, most RHD patients do not reach the age of 40 due to these complications. This stark reality underscores the importance of increasing awareness, improving access to care, and implementing comprehensive prevention and treatment strategies to combat this devastating disease. 

How do I take care of myself in rheumatic heart disease? 

If you have been diagnosed with rheumatic heart disease, taking an active role in your care is essential for managing symptoms and preventing complications. Some key self-care strategies include: 

• Follow your prescribed treatment, including medications and regular follow-ups. 

• Maintain a heart-healthy lifestyle with a balanced diet, doctor-approved exercise, and stress management. 

• Monitor for worsening RHD symptoms like shortness of breath or swelling and inform your doctor immediately. 

When to see a doctor?  

If you suspect that you or your child may have rheumatic fever or rheumatic heart disease, it is crucial to seek medical attention promptly. Early diagnosis and treatment can prevent long-term heart damage and improve outcomes. 

Conclusion 

Rheumatic heart disease (RHD) affects millions globally, especially in low-income regions. Understanding symptoms and risks enables timely care. If you are concerned about your risk of developing RHD or have been diagnosed with the condition, consider exploring the comprehensive diagnostic and health check-up services offered by Metropolis Healthcare. With a commitment to delivering accurate results and personalized care, Metropolis Healthcare empowers patients to prioritize their health and make informed decisions about their well-being.