Rheumatic Heart Disease Treatment in India

Rheumatic heart disease is an acquired heart disease in which the heart valves become damaged due to rheumatic fever. Rheumatic fever is an autoimmune disorder caused due to streptococcal bacteria. The damage to heart valves develops if the rheumatic fever is inadequately treated. If a rheumatic heart disease is left untreated, it can lead to critical health conditions like heart failure.

Associated Anatomy of Rheumatic Heart Disease

Heart

Rheumatic Heart Disease Causes

Rheumatic fever: Rheumatic heart disease is caused due to rheumatic fever. Inadequate treatment of rheumatic fever exacerbates the valve involvement. Rheumatic fever occurs following a throat infection from group A streptococcus infections. Rheumatic fever causes inflammation of heart valves and muscles, resulting in rheumatic heart disease.

Rheumatic Heart Disease Symptoms

Common symptoms of rheumatic fever include-

• Fever
• Fatigue
• Fleeting pain and swelling in joints, especially knees and ankles
• Weakness
• Lumps under the skin (nodules)
• Jerky or uncontrolled movements of facial muscles, arms, and legs (chorea)
• Heart murmur

Symptoms of rheumatic heart disease may not be apparent for many years. When they eventually occur, the symptoms depend on the extent of damage to the heart valves. Some symptoms of rheumatic heart disease include:

• Chest discomfort or Pain
• Fatigue
• Shortness of breath
• Swelling of feet or hands,
• Irregular or rapid heartbeats
• Heart murmur.

Rheumatic Heart Disease Diagnosis

In addition to a thorough medical history analysis and physical exam, the following tests help diagnose rheumatic heart disease-

Blood test

To detect bacteria and inflammation.

Electrocardiogram (ECG)

This test evaluates the electrical conductivity of the heart. It detects abnormal heart rhythms.

Chest X-ray

To check if the heart is enlarged.

Echocardiogram (echo)

This test can diagnose heart valve problems

Cardiac MRI

This test gives detailed heart images to get precise information regarding heart muscles and valves.

Rheumatic Heart Disease Treatment

The damage to the heart valves is permanent. However, treatments can aid in controlling the symptoms and halt the disease progression. Treatments for rheumatic heart disease include-

Drugs

Depending on the severity of rheumatic heart disease, the doctor may use drugs to manage arrhythmia or heart failure (irregular heart rhythm). Anticoagulants may reduce the risks of blood clots or stroke.

Surgery

Heart valve surgery helps in severe cases of rheumatic heart disease which has resulted in permanent damage to the heart valves.

Risk Factors of Rheumatic Heart Disease

People who live in unhealthy conditions and overcrowded places are also at increased risk.

• Improper treatment of streptococcal infections increases the risk of rheumatic heart disease.
• Children or adolescents who get repeated streptococcal infections are the most susceptible to rheumatic heart disease.
• People are at increased risk for rheumatic heart disease if they do not have easy access to medications or health care.

Rheumatic Heart Disease Prevention

Primary Prevention of Rheumatic Heart Disease

• Medications for rheumatic fever: An effective strategy would be to prevent the occurrence of rheumatic fever by using appropriate antibiotics like benzathine penicillin G. It is essential to ensure an entire antibiotic course is completed as prescribed and instructed by the health care provider.
• Improving the quality of life, increasing access to health care, ensuring a constant supply of medications, etc., are some ways of preventing rheumatic heart disease in endemic countries.

Secondary Preventions of Rheumatic Heart Disease

• Long-term antibiotic therapy is critical to halt disease progression to a severe form and prevent additional bacterial infections.

Epidemiology of Rheumatic Heart Disease;

• More than 2,50,000 people succumb to rheumatic heart disease every year, with a majority of the fatalities occurring in middle or low-income countries.
• Rheumatic heart disease is the most common acquired heart disease in people under 25.

Expected Prognosis of Rheumatic Heart Disease

Individuals with well-controlled rheumatic heart disease can have an excellent quality of life, though the condition is life-long and requires long-term therapy. Proper care can delay or halt the development of permanent damage to the heart valves and heart failure.

Natural Progression of Rheumatic Heart Disease

If a rheumatic heart disease is left untreated, it can lead to life-threatening conditions like heart failure.

Pathophysiology of Rheumatic Heart Disease

• Rheumatic heart disease is an autoimmune disorder characterised by damaged heart valves.
• This occurs following repeated episodes of rheumatic fever caused by streptococcal bacteria.
• The human body elicits an immune response generally to fight infections caused due to bacteria, viruses, or other foreign organisms.
• However, in rheumatic fever, the developed immune response starts attacking normal healthy tissues in the heart, skin, central nervous system, etc.
• After repeated episodes of rheumatic fever, the heart valves get damaged, resulting in rheumatic heart disease.
• If it is left untreated, heart failure or death ensues.

Complications of Rheumatic Heart Disease

Rheumatic heart disease may lead to:

• Endocarditis: In this condition, the infection involves the damaged heart valves and becomes difficult to eradicate.
• Pregnancy and delivery complications: Individuals should consult their health care provider if they intend to get pregnant.
• Heart failure: A disease characterised by inadequate pumping of blood by the heart. Leaking or severely narrowed heart valves are important risk factors 
• Atrial fibrillation (irregular, rapid heartbeat), arrhythmia (improper heartbeat, either too slow or fast), and pulmonary hypertension are other possible complications of rheumatic heart disease.