Rheumatic Heart Disease: What to Know

Rheumatic heart disease is a commonly acquired heart disease in children and young adults under the age of 25 years. This serious condition claims over 300,000 lives each year worldwide. It is more common in low- and middle-income countries, where there is little or no access to affordable essential medicines. Please continue reading to learn more.

What is rheumatic heart disease?

Rheumatic heart disease is an acquired heart condition in which the heart valves and other connective tissues in the body become damaged. Heart valves are flaps that ensure blood flow in the correct direction. They allow the heart to pump blood effectively. In people with valve damage, blood leaks backward, which hampers the heart’s ability to pump blood to the body, leading to heart failure.

What is the main cause of severe rheumatic heart disease?

Rheumatic heart disease occurs following one or more episodes of rheumatic fever. Rheumatic fever is an autoimmune inflammatory reaction to streptococcal pharyngitis (strep throat, strep infection, or throat infection) or scarlet fever (a bacterial illness associated with a characteristic pink-red rash). This type of bacterial infection is caused by Streptococcus pyogenes (group A streptococcus).

In other words, sometimes, repeated strep infections cause the immune system to mistakenly attack healthy tissues, including the heart valves, joints, skin, and brain. This abnormal immune response or inflammatory disease is called acute rheumatic fever. It causes inflammation and scarring of the heart valves, which is called rheumatic heart disease.

Rheumatic heart disease typically occurs during childhood and can lead to long-term disability and death.

What are the risk factors for rheumatic heart disease?

Rheumatic heart disease occurs due to untreated or under-treated strep infections. Children who get repeated strep throat infections are at the highest risk of developing rheumatic heart disease.

Is rheumatic heart disease contagious?

Upper respiratory tract infections are contagious and can spread from person to person. An untreated or under-treated streptococcal infection can cause rheumatic fever, which can lead to rheumatic heart disease. However, rheumatic fever itself is an immune response and is not contagious. Similarly, rheumatic heart disease is damage to the heart valves that occurs as a result of rheumatic fever, and it, too, is not contagious.

What are the signs of rheumatic heart disease?

Rheumatic fever symptoms can include:

Fever
Tiredness
Painful, swollen, and tender joints, such as the elbows, wrists, knees, and ankles
Pain that moves from one joint to another
Painless lumps under the skin surface (rare)
A rash consisting of pink rings with clear centers (rare)
Chorea (uncontrolled jerky movements)
Heart murmur (abnormal sound)

The heart valve damage associated with rheumatic heart disease can cause symptoms such as:

Fatigue
Shortness of breath
Chest discomfort or chest pain
Swelling of the hands, feet, or stomach
Rapid or irregular heartbeat

What are the complications of rheumatic heart disease?

Complications of rheumatic heart disease include heart failure because when blood leaks backward through severely narrowed or leaking heart valves, it prevents the heart from pumping blood effectively. Other complications include abnormal heart rhythms such as atrial fibrillation, bacterial endocarditis (an infection of the inner lining of the heart), blood clots, pulmonary hypertension, and a ruptured heart valve, which requires emergency surgical replacement or repair of the valve. In addition, women suffering from rheumatic heart disease can have fetal and maternal cardiac complications during pregnancy and delivery.

How is rheumatic heart disease diagnosed?

Doctors can diagnose rheumatic heart disease based on a recent history of strep infection. They may order a throat culture or blood tests to diagnose a streptococcal infection.

The presence of a heart murmur or rub also helps in diagnosing heart valve problems. These are abnormal heart sounds that can be heard with a stethoscope in people with valvular heart disease. A heart murmur is caused by a leaking heart valve when some blood flows backward due to damaged valve flaps. A rub is heard when heart muscle and other inflamed heart tissues rub against each other.

In addition to a physical exam, blood test for infection and inflammation, and other laboratory tests, doctors use tests such as echocardiogram, electrocardiogram, chest X-ray, and cardiac MRI to diagnose rheumatic heart disease.

How is rheumatic heart disease treated?

The damage caused to the heart valves by rheumatic fever is permanent, and there is no cure for rheumatic heart disease. The treatments for rheumatic heart disease depend on the severity. People with valve disease may need to take medications to manage heart failure or heart rhythm abnormalities or to treat symptoms. Blood thinning medications may be prescribed to lower the risk of blood clots. People with severe rheumatic heart disease usually need surgery to replace or repair the damaged heart valves.

How long can you live with rheumatic heart disease?

How long you can live with rheumatic heart disease depends on a number of factors, such as secondary prevention of recurrent infections that can cause rheumatic fever and lead to further heart valve damage, the degree of valvular damage, and the presence and severity of cardiac complications such as pericarditis, endocarditis, arrhythmias, and congestive heart failure.

How can you prevent rheumatic heart disease?

The best way to prevent rheumatic fever and rheumatic heart disease is to treat strep infections with antibiotics. People who have had rheumatic fever are often prescribed lifelong antibiotic treatment to prevent recurrent infection and reduce the risk of further heart valve damage. Anti-inflammatory medications such as aspirin, nonsteroidal anti-inflammatory drugs, and steroids may also be used to prevent heart valve inflammation, which could lead to rheumatic heart disease.

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