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Rheumatic Heart Diseases: Symptoms, Causes & Treatment

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Rheumatic heart diseases
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Rheumatic heart diseases are a complication of rheumatic fever in which the heart valves are damaged. Rheumatic fever is an autoimmune inflammatory reaction that can follow a throat infection (or sometimes a skin infection) with group A streptococcus bacteria.

It can affect the heart, joints, skin, and brain. It is most common in children and teens aged 5 to 15, because strep throat is most common in that age group. Rheumatic heart disease develops when the inflammation scars the heart valves.

What Are The Main Causes Of Rheumatic Heart Diseases?

Rheumatic heart disease is a late complication of rheumatic fever. According to the CDC, rheumatic fever is most common in children aged 5 to 15 and is rare in children 3 and younger in the United States. There are some factors that make people more likely to get it.

They include age, family history, poverty, overcrowding, and repeated untreated strep throat infections. During rheumatic fever, the immune system attacks the body's own tissues, mostly the joints, skin, brain, and heart. In rheumatic heart disease, the heart valves become inflamed and scarred over time.

Because of this damage, heart valves can become narrow or leaky. This takes years to develop and may lead to heart failure.

Duckett- Jones Criteria for the Rheumatic Fever Diagnosis

There is no single test for rheumatic fever. Doctors use the revised Jones criteria. A first episode is diagnosed when a person has either 2 major criteria, or 1 major and 2 minor criteria, plus evidence of a recent strep infection.

1- Major Criteria

  • Carditis
  • Chorea
  • Polyarthritis
  • Subcutaneous nodules
  • Erythema marginatum

2- Minor Criteria

  • Fever
  • Raised ESR
  • Raised CRP
  • Joint pain in several joints (polyarthralgia)
  • Prolonged PR interval on an ECG

Investigations for the Rheumatic Fever

Laboratory tests help confirm rheumatic fever and the strep infection that came before it. Doctors usually combine them with the clinical findings above.

  • Blood tests may show raised C-reactive protein (CRP), a general marker of inflammation.
  • ESR is raised.
  • An ECG may show a prolonged PR interval. Heart block can occur when inflammation affects the heart.
  • A throat swab or rapid strep test may show group A streptococcus.
  • Strep antibody tests, such as the ASO titer, may be raised or rising.
  • Hemoglobin may be reduced (anemia).
  • A chest x-ray may show an enlarged heart.
  • An echocardiogram (heart ultrasound) checks the valves for damage.

Rheumatic Heart Diseases (Carditis)

Carditis is common in rheumatic fever. Repeated strep infections and repeated attacks of rheumatic fever raise the risk of lasting valve damage. People with rheumatic heart disease may have chest pain, breathlessness, palpitations, and a fast heartbeat.

The heart valves become swollen and inflamed because the immune system reacts against the body's own tissue after the strep infection. Damaged valves do not open or close properly, and heart failure may develop in advanced disease.

Doctors suspect carditis when they find signs such as:

  • Cardiomegaly or enlarged heart
  • High pulse rate during the sleeping
  • Soft first heart sound
  • A new heart murmur
  • Pericardial friction rub

Symptoms of the Rheumatic Heart Diseases

Symptoms of rheumatic fever and rheumatic heart disease can include:

  • Fever
  • Red, swollen, tender and painful joints, often moving from joint to joint
  • Weakness and tiredness
  • Shortness of breath
  • Chest pain
  • Palpitations or an irregular heartbeat
  • Nodules under the skin
  • Raised rashes on the back, arm and the abdomen
  • Involuntary, jerky, purposeless movements of the hands and the feet
  • Swelling of the abdomen, hands, or feet

Risk Factors for the Rheumatic Heart Disease

Untreated or undiagnosed strep throat increases the risk of rheumatic heart disease. Children with repeated strep throat are at higher risk.

Poverty, overcrowding, family history, and age are other important risk factors. According to the WHO, it is the most common acquired heart disease in people under 25.

Management of the Rheumatic Heart Diseases

Treatment is managed by a doctor and depends on how much the heart is affected. See a clinician promptly if you or your child has a sore throat with fever, or joint pain and fever after a sore throat.

1- Bed Rest

Doctors may advise rest while the inflammation is active, especially when carditis is present. Salt is restricted in the case of heart diseases.

2- Antibiotics

Antibiotics clear any remaining strep bacteria. Penicillin is the drug of choice.

After rheumatic fever, people need long-term antibiotics to prevent new strep infections and repeat attacks. A common option is a benzathine penicillin G injection every 3 to 4 weeks, often for many years.

3- Anti-inflammatory drugs

Salicylates (aspirin) and other anti-inflammatory medicines reduce fever and joint inflammation. Steroids are sometimes used for severe carditis. Only use aspirin in a child under a doctor's direction.

What Are The Complications Of Rheumatic Fever?

With proper treatment, chorea and arthritis usually resolve completely. Repeated infections and attacks can cause permanent valve damage.

This can lead to heart failure, abnormal heart rhythms, blood clots, and the need for valve repair or replacement surgery. Rheumatic heart disease also raises risks during pregnancy.

Sources

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