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Rheumatic heart disease

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Overview of rheumatic heart disease

Rheumatic heart disease (RHD) is an acquired heart disease which leads to a damage in the heart and the heart valves and is the most serious complication of rheumatic fever. One common result of rheumatic fever is heart valve damage.

The World Health Organization (WHO) says Rheumatic fever (RF) and rheumatic heart disease (RHD) are nonsuppurative complications of Group A streptococcal pharyngitis due to a delayed immune response. The disease is more prevalent in developing countries where group A streptococcal bacteria is more prone to growth due to lack of proper sanitation.

Symptoms of rheumatic heart disease

There are no standard symptoms for RHD and it may not show any sign in most cases. However, severe cases may have symptoms like:

Causes of rheumatic heart disease

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RHD is caused due another disease called the rheumatic fever. Rheumatic fever is caused group A streptococcal (strep) bacterial infection. Sometimes antibodies released to treat the bacterial infection behave in an abnormal manner and start attacking the body’s own tissues and damaging it. The main reaction to such abnormal behaviour takes place in the heart, where the valves and other tissues in the heart can be damaged. If strep throat is effectively treated with antibiotics rheumatic fever can be prevented, which in turn can prevent RHD.

Diagnosis of rheumatic heart disease

Currently, clinical examination remains the basis of a diagnosis and the role of echocardiography is at the forefront of any diagnosis. However, an echo-Doppler examination should be performed to further help proper diagnosis. The other invasive and noninvasive diagnostic modalities, such as endomyocardial biopsy and radionuclide imaging, should be considered as research tools.

Echocardiography is often considered the best method to detect rheumatic fever and assessment of valve disease of the heart. The method of Radionuclide imaging is also simple and noninvasive and has been commonly used to evaluate a variety of cardiovascular disorders.

Other methods of diagnosis will be a physical examination that can detect a heart murmur, which in turn may suggest looking closely at the medical history of the patient to check if there is any evidence of past acute rheumatoid fever or strep infection. A chest x-ray to check for enlargement of the heart or fluid is also helpful.  

Treatment of rheumatic heart disease

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The first line of treatment for a rheumatic heart disease is generally administering antibiotics to treat the infection. Blood-thinning medicine to prevent stroke or thin blood for replacement valves is also given but it is often seen that both the methods are not very effective.

Balloon valvotomy (commissurotomy)

Balloon valvotomy is a non-surgical procedure that can be performed to treat cases of RHD. Catheters are inserted generally through the carotid artery approach in the groin area and subsequently a balloon tip is directly positioned inside the narrowed valve through a small hole above the heart. Once inside the body, the balloon is filled with air and inflated which in turn widens the narrowed mitral valve. The process of inflating and deflating the balloon can take place several times to get the desired results and once a cardiologist is satisfied with the result he will deflate the balloon and remove the catheter.

This technique is reserved almost entirely for stenosis of the mitral valve.

Surgical treatment

Surgical procedures performed include closed mitral commissurotomy, valve repair and valve replacement. Valve repair techniques and valve replacement in most cases need a more invasive approach in terms of an open-heart surgery. According to John Hopkins transcatheter aortic valve replacement, or TAVR, is a new alternative for some cases of aortic valve stenosis. This hybrid procedure typically is done by a cardiac surgeon and an interventional cardiologist.

If the valve can be repaired by placing a ring to support it but in cases where a heart valve cannot be resurrected an artificial valve maybe needed to replace it.

Prevention of rheumatic heart disease

WHO prescribes that all patients who have undergone intervention treatment for rheumatic heart disease will require regular long-term follow-up. Ideally, this should be done in a centre equipped with echocardiography. One must also ensure that all necessary care is taken to prevent the outbreak of rheumatoid fever.

Written by: Saptakee sengupta
Date last updated: April 12, 2015