Rheumatic Heart Diseases: Types, Symptoms, Causes & Treatment

Rheumatic heart disease is a chronic condition resulting from rheumatic fever, where an untreated or incompletely treated streptococcal infection of the throat can occur. Rheumatic fever causes the body’s inflammatory response to injure a heart valve. Over time, this damage can worsen and cause these heart valves to be scarred, thickened, or deformed, making it hard for them to work as they should.

RHD mainly involves the heart valves, such as the bicuspid and mitral valves. Tricuspid stenosis occurs less frequently. With time, the valves affected by this disease could become stenotic (narrowed and unable to allow sufficient blood flow through the heart) or regurgitant (leaky and permitting backward flow in an incorrect direction). The consequences might take the form of shortness of breath, chest pain, fatigue, palpitations, and swelling in the legs.

While Rheumatic Heart Disease (RHD) itself isn't categorised into distinct types, the way the disease affects the heart valves can vary. Here's a deeper look at the different types of valve damage caused by RHD:

• Valvular Stenosis: This occurs when the opening of a heart valve narrows due to scarring. This restricts blood flow from the heart to the chambers or out to the body. Depending on the severity, stenosis can affect:
  • Mitral Stenosis: The mitral valve, located between the left atrium and ventricle, struggles to open fully, hindering blood flow from the atrium to the ventricle.
  • Aortic Stenosis: The aortic valve, responsible for blood flow from the left ventricle to the aorta (main artery), narrows, obstructing blood flow out of the heart.
  • Tricuspid Stenosis: Less common, this affects the tricuspid valve between the right atrium and ventricle, impeding blood flow from the body to the heart.
  • Pulmonic Stenosis: The pulmonic valve, regulating blood flow from the right ventricle to the lungs, narrows, causing difficulty pumping blood to the lungs.
• Valvular Regurgitation: This happens when the valve leaflets don't close properly, causing blood to leak backward. This disrupts the normal one-way flow of blood through the heart. Similar to stenosis, regurgitation can affect any valve:
  • Mitral Regurgitation: Blood leaks back from the left ventricle to the atrium.
  • Aortic Regurgitation: Blood leaks backward from the aorta to the left ventricle.
  • Tricuspid Regurgitation: Blood leaks back from the right ventricle to the atrium.
  • Pulmonic Regurgitation: Blood leaks backward from the lungs to the right ventricle.
• Combined Stenosis and Regurgitation: In some cases, both stenosis and regurgitation can affect the same valve, causing a more complex issue.

The specific type of valve damage caused by RHD determines the symptoms a person experiences and the course of treatment needed. Early diagnosis and management are crucial to minimise the impact of RHD on your heart health.

Rheumatic heart disease (RHD) can be a silent thief, sometimes showing no symptoms in the early stages. However, as the heart valves become more damaged, you might experience a range of signs that indicate trouble. Here's a breakdown of the common symptoms of RHD:

• Shortness of Breath (Dyspnea): This is a prevalent symptom, especially during physical activity or when lying down. As the heart struggles to pump blood efficiently due to valve dysfunction, the body experiences a lack of oxygen, leading to shortness of breath.
• Fatigue: Constant tiredness and a lack of energy are common complaints with RHD. The heart's compromised function makes it difficult to circulate oxygen-rich blood throughout the body, leading to fatigue.
• Chest Pain (Angina): This pain or discomfort in the chest can be a warning sign of RHD. It often occurs with exertion and might feel like tightness, squeezing, or burning. The pain arises due to reduced blood flow to the heart muscle.
• Palpitations (Irregular Heartbeat): Fluttering, racing, or irregular heartbeats can be unsettling experiences associated with RHD. Damaged valves can disrupt the normal heart rhythm, causing palpitations.
• Swollen Ankles or Feet (Edema): Fluid buildup in the legs is a symptom that might develop in later stages of RHD. When the heart struggles to pump blood forward, it can back up into the veins, causing fluid to accumulate in the ankles and feet.
• Unexplained weight gain: Due to fluid buildup.
• Persistent cough: Fluid accumulation in the lungs can cause a cough.
• Decreased exercise tolerance: Shortness of breath and fatigue can limit physical activity.

Rheumatic heart disease (RHD) develops from a complex chain reaction triggered by a bacterial infection. Here's a breakdown of the process:

1. Group A Streptococcus Infection: The culprit behind RHD is a bacterium called Group A Streptococcus (GAS), commonly known as strep throat. This infection usually causes a sore throat, fever, and swollen lymph nodes.
2. Immune System Overreaction: In some individuals, after a strep throat infection (especially if left untreated or undertreated), the body's immune system overreacts. It mistakenly targets healthy tissues, including the heart valves, along with the bacteria.
3. Rheumatic Fever: This mistaken attack by the immune system leads to rheumatic fever, an inflammatory disease. The inflammation can affect various parts of the body, including the heart, joints, skin, and brain.
4. Heart Valve Damage: In the heart, the inflammation caused by rheumatic fever primarily targets the heart valves. This inflammation damages the delicate tissues of the valves, causing them to thicken and scar.
5. Valve Dysfunction: The scarred valves lose their flexibility and may not open or close properly. This dysfunction can lead to two main problems:
   • Stenosis: The valve opening narrows, obstructing the smooth flow of blood through the heart.
   • Regurgitation: The valve doesn't close tightly, causing blood to leak backward.
6. Rheumatic Heart Disease: The long-term consequence of this valve damage is RHD. The severity of RHD depends on the extent of the damage and the specific valves affected.
7. Genetics: Some people might be genetically predisposed to a more aggressive immune response to strep throat.
8. Socioeconomic Conditions: Overcrowded living conditions and poor access to healthcare can contribute to the spread of strep throat and increase the risk of complications like rheumatic fever.

By understanding this chain reaction, we can appreciate the importance of early diagnosis and treatment of strep throat infections to prevent the development of RHD.

Rheumatic heart disease (RHD) is largely preventable. Here's a detailed breakdown of strategies to minimise your risk:

Be aware of symptoms like sore throat, fever, and swollen glands.

• Seek prompt medical attention: Don't ignore a sore throat. A doctor can diagnose strep throat with a simple throat swab test and prescribe antibiotics.
• Complete the antibiotic course: Even if symptoms improve, it's crucial to finish the entire course of antibiotics as prescribed by your doctor. This ensures complete eradication of the bacteria and minimises the risk of complications like rheumatic fever.
• Frequent handwashing: This is the single most effective way to prevent the spread of strep throat bacteria. Wash your hands thoroughly with soap and water for at least 20 seconds, especially after using the restroom, before eating, and after blowing your nose or coughing.
• Good respiratory hygiene: Cover your mouth and nose with a tissue when coughing or sneezing, and dispose of the tissue properly.
• Avoid close contact with sick individuals: If someone around you has strep throat, maintain a safe distance and encourage them to practise good hygiene.
• Strengthen your immune system: Eat a balanced diet rich in fruits, vegetables, and whole grains. Get adequate sleep and manage stress levels, as these factors contribute to a robust immune system.
• Regular checkups: Schedule regular checkups with your doctor, especially if you have a history of sore throats or have any concerns.
• In some regions: Where strep throat is particularly prevalent, consult your doctor about the possibility of getting tested for past strep throat infections, especially if you have any symptoms suggestive of RHD.
• Vaccinations: Maintain a vaccination schedule to prevent other illnesses that can put additional strain on the heart.

Diagnosing rheumatic heart disease (RHD) often involves a multi-pronged approach, piecing together information from various sources. Here's a closer look at the key tools used:

1. Medical History:

Your doctor will delve into your medical background, inquiring about:

• Past Strep Throat Infections: Having had strep throat, especially if untreated, increases the risk of rheumatic fever and subsequent RHD.
• Current Symptoms: Shortness of breath, fatigue, chest pain, and heart palpitations can all be indicative of RHD.
• Family History: While uncommon, RHD can have a familial link, prompting further investigation.

2. Physical Examination:

A thorough physical exam can reveal clues:

• Heart Sounds: Using a stethoscope, your doctor will listen for abnormal heart sounds, like murmurs, which can indicate valve malfunction.
• Signs of Heart Failure: Fluid buildup in the ankles or signs of fatigue might suggest compromised heart function due to RHD.

3. Imaging Tests:

• Echocardiogram (Echo): This painless ultrasound is the gold standard for diagnosing RHD. It creates detailed images of your heart, allowing doctors to assess the structure and function of your heart valves. By measuring blood flow patterns and valve movement, they can identify stenosis, regurgitation, or other valve abnormalities.
• Chest X-Ray: While not definitive for RHD, a chest X-ray can provide additional information. It might reveal an enlarged heart, a sign of heart failure sometimes associated with RHD.

4. Blood Tests:

• Antistreptolysin O (ASO) Test: This blood test helps detect antibodies produced by the body in response to a strep infection, suggesting a past exposure. However, a positive ASO test alone doesn't confirm RHD.
• C-Reactive Protein (CRP): This test measures inflammation in the body. Elevated CRP levels can support the diagnosis of active rheumatic fever, which might indicate a higher risk of developing RHD.

While Rheumatic Heart Disease (RHD) doesn't progress through clearly defined stages like some other diseases, it's helpful to understand how the severity of valve damage dictates the approach to treatment. Here's an expanded explanation:

Progression of Valve Damage:

RHD develops due to inflammation of the heart valves caused by rheumatic fever. This inflammation can cause scarring and thickening of the valves, impacting their ability to function properly. The severity of this damage determines the course of treatment. Here's a breakdown of how valve damage might progress:

• Mild Damage: The valve opening might be slightly narrowed or leaky, but blood flow remains relatively unimpeded. Often, there are no symptoms at this stage. Regular monitoring with echocardiograms might be sufficient.
• Moderate Damage: The valve function is moderately compromised, leading to some blood flow obstruction or leakage. Symptoms like shortness of breath or fatigue might start to appear. Medications to manage heart function and prevent complications might be prescribed.
• Severe Damage: The valve is significantly narrowed or leaks considerably, causing substantial blood flow problems. Symptoms become more pronounced, and heart failure might develop. This stage often necessitates intervention in the form of valve repair or replacement surgery.

Rheumatic heart disease (RHD) treatment focuses on managing the valve damage and preventing further complications. The approach varies depending on the severity of the condition. Here's a breakdown of the different treatment options:

Medication:

• Antibiotics: Following a strep throat infection, long-term antibiotics like penicillin are often prescribed to prevent recurrent infections and subsequent RHD flare-ups.
• Blood Thinners (Anticoagulants): These medications help prevent blood clots that could form on damaged valves and travel to the brain, causing strokes.
• Diuretics: If heart failure develops due to RHD, diuretics help remove excess fluid buildup in the body, easing symptoms like shortness of breath and swelling.
• Heart Rhythm Medications: Medications like beta-blockers or antiarrhythmics might be used to regulate an irregular heartbeat caused by RHD.
• Anti-inflammatory Medications: In some cases, medications like aspirin or corticosteroids may be used to reduce inflammation in the heart valves.

Minimally Invasive Procedures:

• Balloon Valvuloplasty: This procedure is used primarily for mitral stenosis (narrowing of the mitral valve). A catheter with a balloon is inserted into the heart to open the narrowed valve.

Surgery:

When medication and minimally invasive procedures aren't sufficient, surgery might be necessary:

• Valve Repair (Valvuloplasty): A surgeon repairs the damaged valve to restore its proper function. This is preferred whenever possible.
• Valve Replacement: If repair isn't feasible, the surgeon replaces the damaged valve with a mechanical or biological prosthetic valve.

Long-Term Management:

Following treatment, ongoing management is crucial:

• Regular Checkups: Regular visits with your doctor allow for monitoring of your heart function and valve health.
• Medication Adherence: Taking medications as prescribed is essential to manage symptoms and prevent complications.
• Healthy Lifestyle: Maintaining a healthy weight with a balanced diet and regular exercise reduces stress on the heart and improves overall health.
• Dental Hygiene: Good dental hygiene practices help prevent bacterial infections that could potentially worsen RHD.
• Pregnancy Management: Pregnant women with RHD require close monitoring by a cardiologist to ensure the safety of both mother and baby.

Rheumatic heart disease (RHD) requires ongoing management to ensure your heart health and well-being. Here's a detailed breakdown of the recovery process and aftercare practices:

Immediately After Treatment:

• Recovery Time: This depends on the type of treatment received. Following medication adjustments, recovery might be quicker. If you underwent valve surgery, expect a hospital stay and a longer recovery period at home (several weeks to months).
• Wound Care: If you had surgery, proper wound care is crucial to prevent infection. Follow your doctor's instructions regarding dressing changes and incision site care.
• Physical Therapy: Regaining strength and endurance, especially after surgery, is essential. A physical therapist will guide you through exercises to improve your mobility and heart function.

Long-Term Management:

• Medications: Adherence to prescribed medications is critical. This might include antibiotics to prevent future strep throat infections, medications to manage heart rhythm or blood pressure, and diuretics to reduce fluid buildup if needed.
• Regular Checkups: Schedule regular appointments with your doctor to monitor your heart health. This might involve physical examinations, echocardiograms (ultrasound imaging of the heart), and other tests to assess your valve function and overall heart health.
• Healthy Lifestyle: Maintaining a heart-healthy lifestyle is key. This includes:
  • Diet: Eat a balanced diet rich in fruits, vegetables, and whole grains. Limit saturated and unhealthy fats, salt, and added sugars.
  • Exercise: Regular physical activity, as approved by your doctor, can strengthen your heart and improve your overall fitness. Aim for moderate-intensity exercise for at least 30 minutes most days of the week.
  • Weight Management: Maintaining a healthy weight reduces stress on your heart.
  • Smoking Cessation: Smoking significantly increases the risk of complications from RHD. Quitting smoking is crucial for your heart health.
• Dental Hygiene: Good dental hygiene is essential to prevent bacterial infections, including strep throat, which can worsen RHD. Brush your teeth twice daily and floss regularly.
• Stress Management: Chronic stress can exacerbate heart problems. Find healthy ways to manage stress, such as yoga, meditation, or spending time in nature.
• Pregnancy Considerations: If you plan to become pregnant, discuss it with your doctor beforehand. Depending on the severity of your RHD, you might require additional monitoring during pregnancy.

1. What is Rheumatic Heart Disease (RHD)?
   Rheumatic Heart Disease is a chronic heart condition resulting from damage to the heart valves caused by rheumatic fever, which follows untreated or poorly treated streptococcal throat infection.
2. How does rheumatic fever lead to RHD?
   Rheumatic fever can cause inflammation in various parts of the body, including the heart. The inflammation can damage heart valves, leading to the development of RHD over time.
3. Who is most at risk for RHD?
   Children between ages 5 and 15 are most at risk, especially those in areas with limited access to medical care, crowded living conditions, or recurrent strep throat infections.
4. Can adults get RHD?
   Yes, adults can develop RHD if they had rheumatic fever in childhood. The heart valve damage caused by rheumatic fever can persist and worsen into adulthood.
5. What are the symptoms of RHD?
   Symptoms include shortness of breath, chest pain, fatigue, palpitations, swelling in the legs and feet, and sometimes fainting spells.
6. How is RHD diagnosed?
   Diagnosis involves a combination of medical history, physical exams, and tests such as echocardiograms, electrocardiograms (ECG), and blood tests to assess heart damage and inflammation.
7. Is RHD a common condition?
   RHD is common in developing countries with poor access to healthcare. It has become rare in developed countries due to better treatment of strep throat and improved living conditions.
8. What is the primary cause of rheumatic fever?
   Rheumatic fever is caused by an autoimmune response to an untreated or inadequately treated infection with group A Streptococcus bacteria, which causes strep throat.
9. How can strep throat lead to rheumatic fever?
   If strep throat is not properly treated, the body’s immune response can mistakenly attack its own tissues, including the heart, leading to rheumatic fever.
10. Can rheumatic fever be prevented?
    Yes, rheumatic fever can be prevented by promptly treating strep throat with a full course of appropriate antibiotics.
11. What treatments are available for RHD?
    Treatments include medications to manage symptoms and prevent complications, and in severe cases, surgery to repair or replace damaged heart valves.
12. Can RHD be cured?
    While the heart valve damage from RHD is often permanent, symptoms can be managed, and further damage can be prevented with proper treatment and medical care.
13. What medications are used to treat RHD?
    Medications include antibiotics to prevent strep infections, anti-inflammatory drugs to reduce inflammation, and other medications to manage heart failure or arrhythmias.
14. When is surgery needed for RHD?
    Surgery may be necessary if the heart valve damage is severe and causes significant symptoms or complications, such as heart failure.
15. What types of heart valve surgeries are there for RHD?
    Surgeries include valve repair, where the existing valve is modified to work better, and valve replacement, where the damaged valve is replaced with a mechanical or biological valve.
16. How can rheumatic fever recurrence be prevented?
    Recurrence can be prevented with long-term antibiotic prophylaxis, regular medical follow-ups, and prompt treatment of any new strep infections.
17. Can lifestyle changes help manage RHD?
    Yes, maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding smoking, can help manage symptoms and improve heart health.
18. Are there any complications associated with RHD?
    Complications can include heart failure, atrial fibrillation, stroke, and increased risk of infective endocarditis.
19. What is infective endocarditis?
    Infective endocarditis is an infection of the inner lining of the heart or heart valves, which can be a serious complication of RHD.
20. How is infective endocarditis prevented in RHD patients?
    Prevention includes maintaining good dental hygiene, regular medical check-ups, and possibly taking antibiotics before certain dental or surgical procedures.
21. Can children with RHD lead normal lives?
    With proper treatment and management, many children with RHD can lead relatively normal lives, but they may need regular medical follow-ups and lifestyle adjustments.
22. What role do genetics play in RHD?
    Genetics can play a role, as a family history of rheumatic fever or RHD can increase an individual's susceptibility to the disease.
23. Is there a vaccine for rheumatic fever or RHD?
    Currently, there is no vaccine for rheumatic fever or RHD, but research is ongoing to develop vaccines against group A Streptococcus bacteria.
24. What are the early signs of strep throat?
    Early signs of strep throat include a sore throat, pain when swallowing, red and swollen tonsils, fever, and swollen lymph nodes in the neck.
25. Why is it important to treat strep throat promptly?
    Prompt treatment with antibiotics can prevent rheumatic fever and its complications, including RHD.
26. How long does it take for RHD symptoms to appear after rheumatic fever?
    Symptoms of RHD can appear years or even decades after the initial episode of rheumatic fever, as the heart valve damage progresses over time.
27. Can RHD be detected early?
    Early detection of RHD is possible through regular medical check-ups and echocardiograms, especially in individuals with a history of rheumatic fever.
28. What is the prognosis for someone with RHD?
    The prognosis varies depending on the severity of the valve damage and how well the disease is managed. With proper treatment, many individuals can live productive lives.
29. How common is RHD in developed countries?
    RHD is relatively rare in developed countries due to better healthcare access, improved living conditions, and effective treatment of strep throat.
30. Why is RHD more common in developing countries?
    Higher rates of untreated strep throat, poor living conditions, limited healthcare access, and lower awareness contribute to higher prevalence in developing countries.
31. Can RHD cause heart failure?
    Yes, severe valve damage from RHD can lead to heart failure, where the heart cannot pump blood effectively to meet the body's needs.
32. What are the signs of heart failure in RHD patients?
    Signs include shortness of breath, fatigue, swelling in the legs and abdomen, rapid weight gain, and persistent cough or wheezing.
33. How can heart failure from RHD be managed?
    Management includes medications to reduce symptoms, lifestyle changes, and possibly surgery to repair or replace damaged heart valves.
34. Is regular monitoring necessary for RHD patients?
    Yes, regular medical check-ups and monitoring are crucial to managing RHD, detecting complications early, and adjusting treatment as needed.
35. What role do echocardiograms play in managing RHD?
    Echocardiograms are essential for assessing heart valve function, measuring the severity of valve damage, and guiding treatment decisions.
36. Can RHD affect pregnancy?
    Yes, RHD can complicate pregnancy, increasing the risk of heart failure and other complications. Pregnant women with RHD need specialised care.
37. How can RHD impact daily activities?
    Depending on the severity, RHD can limit physical activity and require adjustments in lifestyle to manage symptoms and prevent complications.
38. What support is available for individuals with RHD?
    Support can include medical care, patient education, lifestyle counselling, and support groups to help manage the condition and improve quality of life.
39. Can children with RHD participate in sports?
    Participation in sports depends on the severity of RHD. Mild cases may allow for physical activity, while severe cases may require restrictions and medical supervision.
40. What is the role of public health initiatives in preventing RHD?
    Public health initiatives focus on improving access to healthcare, educating about strep throat treatment, and improving living conditions to reduce the incidence of rheumatic fever and RHD.
41. How does socioeconomic status influence RHD risk?
    Lower socioeconomic status can lead to crowded living conditions, limited healthcare access, and higher rates of untreated strep throat, increasing the risk of rheumatic fever and RHD.
42. Are there any new treatments being developed for RHD?
    Research is ongoing to develop new treatments, including better antibiotics, anti-inflammatory drugs, and potential vaccines against group A Streptococcus.
43. What are the long-term effects of RHD?
    Long-term effects can include chronic heart valve damage, recurrent heart problems, and increased risk of complications like heart failure and stroke.
44. Can RHD recur after treatment?
    While the heart valve damage is permanent, recurrence of rheumatic fever can be prevented with ongoing antibiotic prophylaxis and regular medical care.
45. What is the global impact of RHD?
    RHD affects millions globally, particularly in low-resource settings, contributing to significant morbidity and mortality, especially among young adults.
46. How can awareness about RHD be increased?
    Awareness can be increased through education campaigns, healthcare provider training, and community outreach programs focusing on strep throat treatment and RHD prevention.
47. What lifestyle changes can help manage RHD?
    Healthy eating, regular exercise, avoiding smoking, maintaining a healthy weight, and managing stress can help manage RHD and improve overall heart health.
48. What is the role of patient education in RHD management?
    Patient education is crucial for understanding the disease, adhering to treatment, recognizing symptoms, and making informed decisions about health and lifestyle.
49. Can RHD be completely prevented?
    While not all cases can be prevented, the risk can be significantly reduced by promptly treating strep throat, preventing rheumatic fever recurrences, and improving public health measures.
50. What are the goals of RHD treatment?
    The goals are to relieve symptoms, prevent further heart damage, manage complications, and improve the patient’s quality of life and life expectancy.