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Rheumatic heart disease: How fevers could trigger a heart condition
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Rheumatic heart disease: How fevers could trigger a heart condition

Rheumatic heart disease is caused by rheumatic fever and usually goes undiagnosed as it does not present with any symptoms for years

Rheumatic heart disease (RHD) is a complication of rheumatic fever, caused by bacterial infection

Rheumatic fever, caused by streptococcus bacteria, makes your body’s immune system react against healthy tissues, affecting the skin, joints, brain and heart. The skin and joint manifestations are usually temporary but when it affects the heart, rheumatoid heart disease (RHD) could have serious health complications.

“When the bacteria infect the body, antibodies react against these antigens and some of them cross-attack the body organs. The skin and joint manifestations are temporary. When it affects the brain, it can cause jerky movements. The most dangerous manifestation is in the heart, leading to a leaky heart valve and weakening of heart muscles and in the severe stage, heart failure,” says Dr Sunil Dwivedi, consultant, cardiology, Manipal Hospital Millers Road, Bengaluru.

He adds in mild cases, the heart disease is diagnosed much later. “The person will not notice it because it is mild, like any other fever. Everybody will not have severe manifestations or joint pain and high fever,” he says.

Rheumatic heart disease symptoms

Dr Rakesh Yadav, professor of cardiology at AIIMS, New Delhi, points out that if there are repeated infections or the infections are severe, it can lead to permanent damage to the heart. “Usually, it is not diagnosed until it is very severe because it doesn’t present any symptoms. When the heart valve gets affected, it fails to close properly and gets leaky (leaky heart valve or valve regurgitation). There are four valves in the heart – mitral, aortic, tricuspid and pulmonary valve. The most common valve involved is a mitral valve. RHD can also cause stenosis of the valve or narrowing of the valve,” he says, adding that severe regurgitation can ultimately lead to damage of the heart muscle or increase valve rupture, which causes breathlessness, unconsciousness and palpitations. It also causes irregularities in the heartbeat, which is known as atrial fibrillation or flutter.

According to a recent article by Clarissa Dass and Arun Kanmanthareddy, RHD accounts for approximately 15 to 20 per cent of all patients with heart failure in endemic countries. Dr Yadav says, “The incidence of rheumatic heart disease is more in developing countries or under-developed countries due to overcrowding and repeated and untreated streptococci infections. The incidence is gradually decreasing in India.”

The prevalence is more in children as they are more prone to infection. Dr Dwivedi adds, “Sore throat infections are transmissible through coughing and inhalation. It takes a few weeks to develop into rheumatic fever. Not all streptococci bacterial infections lead to rheumatic fever.” Depending upon the severity of the infections, RHD can present symptoms between the age of five and 15. It is usually diagnosed by auscultation (listening to the sounds in the heart) or an echocardiogram.

Rheumatic heart disease treatment  

In cases of mild valve issues, Dr Yadav says it is important to ensure there are no repeat incidents of rheumatic fever. “The most standard measure for prevention of repeated streptococci infections, which can lead to rheumatic fever and RHD is penicillin,” he says, adding that in severe cases, some may require medicines to control their heart rate and increase urine output and surgeries for valve replacement.

The heart damage due to rheumatic fever cannot be reversed. Dr Dwivedi says, “Once it develops and causes damage, you just treat it and reduce the future damage, but you cannot reverse it.” He says that in severe cases, people may require a lot of treatment and medications, and some may also get heart failure. “In the milder form of the disease, people can live their whole lives without any major complications,” he adds.

Dr Yadav recalls a case of a 15-year-old girl. She had developed breathlessness and her family thought that it was because she was too lean. “While running, she suddenly collapsed and was taken to a physician who realised something was wrong with her heartbeat. She was referred to a cardiologist where mitral valve leakage was diagnosed. Her aortic valve had also narrowed. She was then referred to us and underwent aortic valve replacement and mitral valve repair. As she was young, she was given a metallic valve, which requires one to be on a long-term blood thinner. Otherwise, she’s leading a normal life,” he narrates.

Takeaways

  • Rheumatic heart disease (RHD) is a complication of rheumatic fever, caused by bacterial infection.
  • The prevalence of RHD is more in developing and under-developed countries due to overcrowding and it affects children between five and 15.
  • Depending on the severity of the infection, it can lead to a leaky heart valve, atrial fibrillation and also heart failure.
  • Rheumatic heart disease cannot be reversed but the damage can be controlled through timely diagnosis.

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