Rheumatic heart disease (RHD)

Rheumatic heart disease (RHD) is a serious condition that affects the heart valves and is commonly seen in developing countries. According to the World Health Organization (WHO), RHD is responsible for 250,000 deaths of young people worldwide each year. RHD is a post-infectious result of acute rheumatic fever, which is caused by an autoimmune inflammatory reaction to a bacterial infection, specifically streptococcal pharyngitis or strep throat. 

When a person contracts rheumatic fever, many connective tissues throughout the body can be affected, including those in the heart, joints, skin, and brain. Over time, the heart valves can become swollen and deformed, leading to narrowing or leaking valves, which makes it harder for the heart to work normally. If left untreated, RHD can eventually cause heart failure, which can be fatal. 

There are several types of heart problems that can be linked to RHD, with the most common being valvular heart disease. Other forms of heart problems that can be associated with RHD include pericarditis, which is inflammation and damage to the outer layer of the heart sac; endocarditis, which is inflammation of the inner lining or layer of the heart; and heart block, which makes the heartbeat slow or skip beats and prevents the heart from pumping blood effectively. 

RHD is caused by an abnormal immune response to streptococcal pharyngitis that leads to deformity of the valve. The damage can cause valvular stenosis and/or regurgitation. RHD typically develops in stages, with acute rheumatic fever occurring around three weeks after group A streptococcal pharyngitis. After multiple episodes of rheumatic fever, fibrosis of heart valves can occur, which can cause rheumatic valvular heart disease. If the valves remain untreated, heart failure and death may occur. 

Screening for RHD is essential to ensure early detection and effective treatment. An echocardiogram (echo) is a sensitive and cost-effective method to screen for RHD. During the test, ultrasound (high-frequency sound waves) from a hand-held wand placed on the chest provides pictures of the heart's valves and chambers, and helps to evaluate the pumping action of the heart. An echo can detect the valve flaps, leaky valve, fluid around the heart, and heart enlargement. It is the most useful test for diagnosing heart valve problems. 

Other tests that may be used to screen for RHD include an electrocardiogram (ECG), a chest X-ray, cardiac MRI, and blood tests. An ECG records the strength and timing of the electrical activity of the heart, showing abnormal rhythms (arrhythmias or dysrhythmias) and can sometimes detect heart muscle damage. A chest X-ray is done to check the lungs and heart enlargement, while a cardiac MRI is an imaging test that takes detailed pictures of the heart and may be used to get a more precise look at the heart valves and heart muscle. Blood tests may also be used to check infection and inflammation. 

The treatment of RHD depends upon the severity and damage to the heart valve. In severe cases, surgeries are done to replace or repair the damaged valve. However, the best treatment is to prevent rheumatic fever from occurring in the first place. People with rheumatic fever are often given daily or monthly antibiotic treatment to prevent recurrent infections and lower the risk of further heart damage. Medicines like aspirin, steroids, etc may also be prescribed. 

If you or someone you know is experiencing symptoms of RHD, it's important to seek medical attention right away. At Sterling Hospitals Gurukul Ahmedabad, the cardiology department is equipped with the latest