Rheumatic Heart Disease

Rheumatic heart disease (RHD) is a condition wherein the heart valves have been damaged due to chronic rheumatic fever. RHD is a major cause of cardiovascular disease in resource-limited nations and children are the predominant population affected. In this condition, there is abnormal blood flow between the chambers of the heart and if left untreated, this could eventually lead to heart failure, stroke, and death.

Last Updated: February 21, 2024

RHD is caused by chronic rheumatic fever. This is an inflammatory infection caused by group A streptococcus that affects different connective tissue in the body. These include those found in the joints, skin, brain, and heart. When the heart is affected, the valves are damaged which eventually leads to scarring and impaired function. 

 

Serious or repeated strep infections increase the risk of developing rheumatic fever and RHD so it is important to get proper treatment of milder conditions to prevent them from progressing into more complicated forms.

The early phases of RHD can be asymptomatic as there is still minimal damage to the valves but the following symptoms are linked to heart failure which manifest in the later stages of the disease:

  • Fatigue
  • Shortness of breath
  • Chest pain
  • Swelling

 

RHD and rheumatic fever can occur at the same time and the following are some symptoms of rheumatic fever that can accompany heart failure:

  • Fever
  • Swollen and tender joints
  • Lumps (nodules under the skin)
  • Red, raised, rashes on the chest, back, or abdomen

A recent history of rheumatic fever or strep infection are key to diagnosing patients with rheumatic heart disease. Physicians can also listen to the heart sounds of the patient and observe for any murmurs that present with valvular impairment.

 

To confirm suspected heart damage, an echocardiogram is performed to look at the heart and see how the valves work in real time. This is the most useful test for diagnosing heart valve problems as this can allow the doctor to see multiple things at once such as fluid buildup around the heart and the backflow of blood through the impaired valves.

 

In addition, an electrocardiogram is done to see if the electrical activity of the heart is affected. A chest x-ray is also performed to see if there is any enlargement of the heart. Lastly, certain blood tests are requested to check for recent signs of infection.

 

 The first step to treating RHD is done by fighting the initial strep infection with proper antibiotics such as oral penicillin, ampicillin, and amoxicillin. These are prescribed by the physician according to the cause of RHD. The second part of treatment is done by managing heart failure through a combination of medications that the physician gives depending on the type of heart failure.

 

In the most severe cases of RHD and rheumatic fever, surgery is done to replace the damaged heart valves and lifelong prophylactic antibiotics are given to prevent the disease from recurring.

The primary prevention for RHD is the immediate diagnosis and treatment of group A streptococcal infection. This would prevent the bacteria from invading the heart and causing damage to the valves.The secondary prevention, as mentioned before, is antibiotic prophylaxis to prevent future infections from happening. 

 

References:

Zuhlke, L., & Cupido, B. (2021). Management and prevention of rheumatic heart disease. UpToDate. https://www.uptodate.com/contents/management-and-prevention-of-rheumatic-heart-disease

Zuhlke, L., & Peters, F. (2022). Clinical manifestations and diagnosis of rheumatic heart disease. UpToDate.https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rheumatic-heart-disease

Last Updated: February 21, 2024