Rheumatic Heart Disease Causes, Types And Treatment

Rheumatic heart disease is a serious condition caused by rheumatic fever that damages the heart valves. Rheumatic fever is an auto-immune disease that occurs as a result of group A streptococcal pharyngeal infection. In an auto-immune disease, your immune system attacks the healthy cells and causes different chronic diseases. Rheumatic disease affects the heart, joints, central nervous system, skin and subcutaneous tissues. Rheumatic fever can occur in both male and females but symptoms can be serious in females. RF is more common in childhood. It is estimated that 40-60% of patients with rheumatic fever develop rheumatic heart disease. Rheumatic heart disease has the ability to affect all heart valves particularly mitral and aortic.

Causes

The major causes responsible for the development of rheumatic heart diseases are,

• Rheumatic fever
• Group A beta-hemolytic streptococcus
• Weakened immune system
• Certain dental or oral procedures (Allowing bacteria to enter the bloodstream)

When the pathogen such as group A beta-hemolytic streptococcus enters the bloodstream, it causes sore throat. If the sore throat is left untreated, it results in the development of rheumatic fever. This fever affects all layers of the heart and inflammation of the mitral valve occurs. Then the abnormal growth of valves occurs, resulting in narrowing of blood vessels. This narrowing of blood vessels reduces blood flow and causes backward flow, resulting in heart failure.

Symptoms

The clinical manifestations of rheumatic heart disease includes,

• Fever (Low grade fever for about 3 months)
• Carditis (Inflammation of heart)
• Polyarthritis (Inflammation of major body joints such as knee, ankle, elbow and wrist)
• Chorea (It is a movement disorder that causes purposeless and unpredictable muscle movements)
• Subcutaneous nodules ( Located in the deep layer of skin such as dermis and subcutis)
• Erythema marginatum (Pink, non-pruritic rashes that appear on trunk and extremities)
• Leukocytosis
• Raised erythrocytes sedimentation
• Fatigue 
• Polyarthralgia
• Cholera
• Weight loss
• Stomach pain

Treatment

There is no effective treatment available for rheumatic heart disease. The damage to the heart valves is permanent. Symptomatic treatment is given to reduce the severity of symptoms. The surgery is required to treat the damage of heart valves by repairing and replacing these valves. Antibiotics should be given in patients with rheumatic heart disease to prevent endocarditis caused by bacteria. Corticosteroids should be prescribed to treat the inflammation of the heart. If heart failure occurs as a result of damage to the heart valves, then beta blockers, diuretics and ACE inhibitors are also prescribed. If you have rheumatic fever, then you should take antibiotics until you are 30 years old. Prophylactic therapy is given after rheumatic fever to reduce the risk of rheumatic heart disease. Initially, an antibiotic is given to treat streptococcal infection. Then benzathine penicillin G is given through the intramuscular route every 4 weeks.

Surgical Treatment

The surgical options for the treatment of rheumatic heart disease are,

• Mitral valvotomy
• Mitral valve replacement
• Percutaneous balloon valvuloplasty

Complications

The complications that occur as a result of rheumatic heart disease are,

• Heart failure
• Bacterial endocarditis
• Ruptured heart valve
• Complications of pregnancy