Rheumatic heart diseases are a complication of rheumatic fever in which the heart valves are being damaged. Rheumatic fever is an inflammatory condition after the nasopharyngeal infection by streptococcus bacteria. It can affect all the body tissues but mainly the heart, bones, joints, skin, and brain. This can involve all the age groups but especially children of 5 to 15 years because strep sore throat is most common in the children. Hence, rheumatic heart diseases occur in the late stage when rheumatic fever affects the heart and valves.
What Are The Main Causes Of Rheumatic Heart Diseases?
Rheumatic heart diseases mainly caused by rheumatic fever, or you can say it is a late complication of rheumatic fever. Rheumatic fever is caused by Streptococci bacteria at the age of 5 to 15 years. It is rare below 5 years of age. It can equally affect both men and women. There are some predisposing factors that can susceptible to rheumatic fever.
They are the age of the patient, season, family history, poverty, overcrowding, and recurrent nasopharyngeal infections. Rheumatic fever can affect all the body tissues but mostly joints, skin, brain, heart, and bones are mostly infected. A complication, rheumatic heart diseases, heart valves become inflamed, swollen, edematous, and scarred over time.
Due to this inflammation, heart valves become narrow, leaky, and become unable to contract passively. This complication takes a long time to develop and may cause heart failure.
Duckett- Jones Criteria for the Rheumatic Fever Diagnosis
To confirm the diagnosis of rheumatic fever, at least two major and one minor criterion must be present in the affected patient. These criteria are
1- Major Criteria
Following manifestations are the evidence of preceding sore throat or streptococcal infections and the high future chances of rheumatic fever. They are
- Subcutaneous nodules
- Erythema marginatum
2- Minor Criteria
- Raised ESR
- Raised CRP
Investigations for the Rheumatic Fever
Some laboratory tests are the diagnostic tests for the confirmation of the rheumatic fever or preceding streptococcal infections. These following investigations are enough to declare the rheumatic fever.
- Complete blood tests show Elevated C reactive proteins which are the main evidence of strep infections.
- ESR is raised.
- On ECG, the P interval is prolonged. QT interval is prolonged and may cause complete heart block may occur due to inflammation of the heart valves.
- Throat swab or blood culture shows the streptococcal organism.
- ASO tiger is raised above the 200 Todd units per ml.
- hemoglobin is reduced and might cause anemia.
- A chest x-ray shows a cardiac enlargement.
Rheumatic Heart Diseases (Carditis)
Almost 50 to 60 percent of cases of rheumatic fever developed rheumatic carditis. Recurrent attacks of streptococcal infections are the most common cause of rheumatic heart diseases in the future. Patients having rheumatic heart disease present with chest pain, breathlessness, palpitations, and tachycardia. Heart valves become swollen and inflamed due to the inflammation by the immune system against the streptococcal organism. Due to swollen valves, they lose their efficacy to contract or relax efficiently and heart failure may occur in an advanced stage.
Risk of the carditis is suspected of there is the following signs
- Cardiomegaly or enlarged heart
- High pulse rate during the sleeping
- Soft first heart sound
- Pericardial friction rub
Symptoms of the Rheumatic Heart Diseases
The most common symptoms of rheumatic heart disease are
- Red, swollen, tender and painful joints
- Shortness of breath
- Chest pain
- Raised rashes on the back, arm and the abdomen
- Involuntary, jerky, purposeless movements of the hands and the feet
Risk Factors for the Rheumatic Heart Disease
Untreated or undiagnosed streptococcal throat infections increase the risk of rheumatic heart diseases. Children with a recurrent sore throat are at a high risk of having rheumatic fever and rheumatic heart diseases. Furthermore, poverty, overcrowding, recurrent throat infections, strong family history, and the age of the patients are the other most important risk factors for rheumatic heart diseases.
Management of the Rheumatic Heart Diseases
1- Bed Rest
The patient is advised to take complete bed rest for the minimum of 2 to 4 weeks in case of carditis until the inflammatory symptoms disappeared. Salt is restricted in the case of heart diseases.
The main essential part is to eradicate the streptococcal organisms by giving antibiotics. Benzylpenicillin is a drug of choice.
3- Anti-inflammatory drugs
Salicylates (aspirin) and steroids are the drug of choice for rheumatic fever but they are not much curative and required a long time to treat.
What Are The Complications Of Rheumatic Fever?
Proper treatment can decrease the risk of chorea and arthritis resolved completely. Long term treatment with recurrent infections can cause heart diseases such as congestive heart failure, heart attack, arrhythmia.