Rheumatic Heart Disease: What You Need to Know

Rheumatic heart disease (RHD) is a condition in which the heart valves are permanently damaged by rheumatic fever. The heart valve damage may start shortly after an untreated or undertreated streptococcal infection, such as strep throat or scarlet fever. While this condition has become rare in wealthy nations, it remains a major health challenge in South Asia and other developing regions.

At Sterling Hospitals, we believe that understanding the connection between a simple sore throat and serious heart damage is the first step toward prevention. RHD affects between 40 and 55 million people globally and claims hundreds of thousands of lives every year. The tragedy of this disease is that it is preventable.

Understanding the Cause

The path to rheumatic heart disease begins with a common bacterial infection known as group A streptococcal pharyngitis, or strep throat. If this infection is not treated properly with antibiotics, it can trigger an autoimmune reaction in the body about two to four weeks later. This reaction is called acute rheumatic fever.

During rheumatic fever, the body’s immune system tries to fight the bacteria. However, the tissues of the heart valves share a similar molecular structure to the bacteria. This case of mistaken identity causes the immune system to attack the heart’s own tissues. This inflammation can cause scarring and stiffness in the valve flaps.

Over time, this damage disrupts the normal flow of blood through the heart. It usually affects the left side of the heart, specifically the mitral valve and the aortic valve.

Who is at Risk?

Rheumatic fever mostly affects children and adolescents between the ages of 5 and 15. However, the permanent heart damage may not show symptoms until a person is a young adult.

Living conditions play a large role in the spread of the bacteria. Overcrowding and limited access to medical care increase the risk of repeated strep infections. In India and other parts of South Asia, the burden of this disease remains high. Repeated episodes of rheumatic fever cause cumulative damage to the heart valves. This is why preventing the recurrence of infection is a primary goal.

How RHD Affects the Heart Valves

The inflammation from rheumatic fever changes the shape and flexibility of the heart valves. This can lead to two main problems:

• Valve Stenosis: The valve opening becomes narrowed. The valve flaps may fuse together or become stiff and thickened. This prevents the valve from opening fully and reduces blood flow. The heart has to work harder to pump blood through the narrow opening.
• Valve Regurgitation: The valve does not close tightly. This allows blood to leak backward in the wrong direction. The heart must pump more blood to make up for the leak

The mitral valve is affected in a large majority of cases. Damage to the aortic valve is also common, while the tricuspid valve is affected less often.

Recognising the Symptoms

Symptoms of rheumatic heart disease often depend on how much damage the valves have sustained. Some people may not notice issues for years after the initial fever. When symptoms do appear, they often include:

• Shortness of breath, especially during physical activity or when lying flat
• Chest pain or discomfort
• Fatigue and weakness
• Swelling in the stomach, hands, or feet
• A sensation of a rapid or irregular heartbeat (palpitations)

If you experience these symptoms and have a history of rheumatic fever, it is vital to consult a doctor. We have the best cardiologist in Ahmedabad available to evaluate your history and current condition.

Diagnosis

Diagnosing RHD involves a review of your medical history and a physical exam. A doctor will listen to your heart for a specific sound called a murmur. This sound is caused by blood flowing through a damaged valve.

To confirm the diagnosis, we use several tests:

• Echocardiogram: This ultrasound of the heart is the most useful test. It allows doctors to see the moving pictures of the heart valves and assess the severity of the damage.
• Electrocardiogram (ECG): This records the electrical activity of the heart and detects irregular rhythms.
• Chest X-ray: This can show if the heart is enlarged or if there is fluid in the lungs.

Treatment Options

There is no cure for rheumatic heart disease, but the condition can be managed effectively. The goal of treatment is to prevent further damage and manage symptoms.

Medications

• Antibiotics: This is the cornerstone of treatment. Patients often require long-term antibiotics every three to four weeks, to prevent the return of strep infections. This can continue for 10 years or until age 40, depending on the severity.
• Blood Thinners: These reduce the risk of stroke or blood clots, especially if the patient has a heart rhythm disorder like atrial fibrillation.
• Heart Failure Medications: These help the heart pump more effectively and remove excess fluid from the body.

Procedures and Surgery

If the heart valves are severely damaged, intervention may be necessary.

• Balloon Valvuloplasty: For some cases of valve narrowing, a doctor can insert a balloon through a blood vessel to widen the valve opening. This is a procedure done without open-heart surgery.
• Valve Repair: Surgeons can sometimes repair the damaged valve to help it function better. This preserves the natural heart tissue.
• Valve Replacement: If the valve is too damaged to repair, it may need to be replaced with a mechanical or biological valve.

We are proud to be a heart specialist hospital in ahmedabad equipped with advanced cath labs and surgical suites to perform these complex procedures safely.

Pregnancy and Rheumatic Heart Disease

Pregnancy puts extra strain on the heart because the volume of blood in the body increases. For women with RHD, this can be dangerous. It is a leading cause of heart-related complications during pregnancy in our region.

Women with RHD who plan to become pregnant should discuss their condition with a healthcare provider beforehand. Close monitoring throughout the pregnancy is essential to ensure the safety of both the mother and the baby.

Prevention Strategies

The most effective way to prevent rheumatic heart disease is to treat strep throat infections promptly. If you or your child has a sore throat with a fever, swollen lymph nodes, or pain when swallowing, seek medical attention. A simple course of antibiotics can stop the immune reaction that leads to heart damage.

For those who have already had rheumatic fever, sticking to the schedule of preventative antibiotics is crucial. Missing doses can leave the body vulnerable to another attack, which causes further damage to the heart valves.

Living with RHD

Living with this condition requires regular medical checkups. You may need to limit certain physical activities depending on the severity of your valve disease. Dental hygiene is also important, as bacteria from the mouth can enter the bloodstream and cause infections in damaged heart valves.

At Sterling Hospitals, we provide you with the utmost care and comfort throughout your journey to a healthier heart. If you are looking for the best  cardiovascular surgeons in Ahmedabad, Vadodara, Rajkot, or Gandhidham, we've got you.

With considerable years of experience, we have built a team of thebest cardiologists in these regions to provide you with premium treatment and the best results.Contact Sterling Hospitals to schedule a consultation and embark on a journey towards a healthier heart.