Rheumatic Heart Disease: An Unsuspecting Threat

Rheumatic heart disease is an inflammatory condition that is loosely defined as chronic damage to a persons heart valves. Should a person is afflicted with rheumatic heart disease, they could suffer heart failure, which could lead to death. The disease gets its name because it is similar in presentation to rheumatism and is the worst-case complication from rheumatic fever.

Rheumatic fever most commonly presents itself within two to three weeks following an infection of Streptococcus pyogenes.

So the fever can be on-set even after the sore throat or other infection of Streptococcus pyogenes has dissipated. It is most prominent in children, but can also be found in adults, with only around 20% of cases being seen in adults.

Before the development of penicillin antibiotics, rheumatic fever was one of the major causes of heart disease and death in adolescents, with thousands dying each year. In the US, rheumatic heart disease is no longer a major cause of death due to early prevention and treatment. The mortality rate of this heart disease in the US is right above 0%. Since rheumatic heart disease cases have been on the decline for decades, it is not a well-known or talked about topic. Rheumatic heart disease is not a complication many people know exists from having a Streptococcus pyogenes infection.

How Rheumatic Heart Disease Develops

Rheumatic heart disease is caused by rheumatic fever. Rheumatic fever is brought on and caused by the bacteria Streptococcus pyogenes, which commonly causes strep throat. Rheumatic fever usually presents after a person has strep throat.

Rheumatic Heart Disease: An Unsuspecting Threat
By: Theis Kofoed Hjorth

When an infection of Streptococcus pyogenes, such as strep throat, is not treated or is treated improperly, a rheumatic fever may possibly develop. It is believed that rheumatic fever is brought on by an autoimmune disorder. If the antibodies in your system become dazed or disconnected, they can start to attack different areas of the body, causing inflammation. About 50% of people that get rheumatic heart fever end up with inflammation of the heart.

Rheumatic fever works throughout the entire body and causes widespread inflammation in the skin, bones, joints, liver, stomach, and the heart. Inflammation of the heart is called carditis. Rheumatic fever may possibly inflame all areas of the heart including the interior, exterior, and the actual heart muscle.

When carditis occurs from rheumatic fever, it causes rheumatic heart disease. The inflammation works its way throughout the heart. The most detrimental inflammation that can occur a persons heart valves. When the heart valves are inflamed and damaged, it is called rheumatic valvular disease. This disease continues to get worse over time and causes the process of this disease to speed up, eventually leading to heart failure.

Other heart problems can arise from rheumatic heart disease. There are three main complications of the heart that are a result of rheumatic disease.

● Atrial fibrillation causes heart arrhythmias, or irregular heart beats, and by itself is not a death sentence. However, atrial fibrillation can cause other complications. The main concern with atrial fibrillation is blood clots that could lead to either a heart attack or a stroke.
● The most common heart complication from rheumatic heart disease is mitral valve disease. This causes the mitral valve in the heart to become coated with deposits of calcium. The calcium deposits can cause dysfunction in the heart by not allowing the mitral valve to open and close properly.
● Aortic valve disease is also caused by large deposits of calcium, but these are in the aortic valves. The calcium deposits can cause damage to the valve, or can cause the valve to not function properly by not opening and closing as it should. This could lead to decreased blood flow to the heart, causing heart failure.

Symptoms of Rheumatic Fever

There are dozens of symptoms that may be present in rheumatic fever, which causes rheumatic heart disease. The most common symptom reported is chest pain, which is caused by the inflammation of the heart. Other symptoms to look for are:

● Muscle movements that are involuntary. This includes muscles spasms and short, graceful muscle movements that were not intended.
● Any type of rash whose origin is unknown
● Mid-grade to high fever
● Weakness throughout the body or limbs
Unintended weight loss
● Excessive sweating
● Headaches
● New arthritis that is affecting more than one joint
● Pain in the joints that seems to move from one joint to another
● Changes in personality such as excessive anger or happiness, or a shortened attention span
● Shortness of breath
● Nosebleeds
● Abdominal pain

Any of the above symptoms following an infection of Streptococcus pyogenes could be a sign of rheumatic fever. Other symptoms could also be present and should be checked out by a doctor immediately to rule out rheumatic fever or heart disease.

How Rheumatic Heart Disease is Diagnosed

The diagnosis for rheumatic heart disease can be tricky, since symptoms could also be caused by or associated with other conditions. There are certain criteria a person will have to test positive for in order to receive a diagnosis of this disease.

Meeting a few of the criteria could give you a diagnosis of rheumatic disease. Some criteria include:

● High-grade fever
● Joint pain that does not have swelling
● Positive throat culture for strep bacteria, or a recent diagnosis for having had strep throat
● Positive ECG test results that show a blockage in the heart
● Nodules that have developed over bones or joints
● Heart murmur or arrhythmia
● Positive test results for inflammation of the heart muscle or heart valve

Your doctor will run a battery of tests such as X-rays and blood tests, as well as thoroughly question you about any symptoms you have experienced. Usually the first question asked when rheumatic heart disease is considered is if you have had an infection of strep within the last few months.

Sometimes symptoms of such a disease may not present themselves until months after the strep throat or other strep-related infection has went away. Rheumatic heart disease can take weeks or even months to show symptoms or cause serious problems.

It is important that you see a doctor if you think you may have a rheumatic fever that could lead to rheumatic heart disease.

Preventing and Treating Rheumatic Heart Disease

The best prevention for rheumatic heart disease is to keep rheumatic fever from ever setting in. If you suspect you have strep throat or another type of Streptococcus pyogenes infection, you should see a doctor immediately. The most common course of treatment is antibiotics, usually penicillin. The antibiotics help to fight off the strep bacteria, preventing rheumatic fever from ever developing so it cannot cause rheumatic heart disease.

If rheumatic fever or heart disease is already present, there are a few treatment options depending on the severity of the disease.

Medications may be administered to decrease the inflammation in the heart. Steroids may be given to help strengthen the heart muscle, especially if there has been an arrhythmia or if deterioration of the heart muscles is found. Prescription medications as well as aspirin are commonly used to combat the inflammation and thin the blood for better blood flow to the heart. Aspirin also helps with any swelling and pain in the joints.

People who have had to have antibiotic medications to treat rheumatic fever may have to continue to take the antibiotics on a regular basis for a long period of time. This is important because if rheumatic fever was to return, it could damage the heart valves in a short period of time. You would also be required to have regular well-checks to ensure no changes have occurred in the heart.

The most serious treatment option available is surgery. If damage to the heart valves are great, surgery may need to be done to either repair or completely replace the valve. When significant damage is done to the heart from rheumatic heart disease, a complete heart transplant may be required to avoid death.

Long-Term Complications

Once you have had rheumatic fever or rheumatic heart disease, there could be many long-term complications and problems you have to deal with.

You will have to regularly see your doctor or cardiologist to check the heart for new damage or changes. You may also have to take medications long-term to prevent further damage or recurrences of the fever or disease. Once you have had rheumatic fever one time, your chances of getting it again are drastically increased.

Majority of the long-term complications you face are different types of damage to the heart. You could develop heart murmurs, damaged valves, blood clots, and narrowing of the valves. Any of these can be serious and lead to heart failure or death.

If you had rheumatic fever that was treated and resolved, you still could face developing rheumatic heart disease.