Rheumatic heart disease is a significant health burden. About 33 million people are living with the condition globally. With an estimated 13.2 million of these 33 million living in India, our country is home to 40 per cent of all people living with Rheumatic heart disease.
Rheumatic fever occurs due to changes in the immune system as a response to streptococcal throat and other infections caused by Group A Streptococcal infection. Inflammation of the heart, joints, brain, and skin are the hallmark symptoms of rheumatic fever. This happens because the immune system mistakes these areas for an infection and attacks them. Typically, the symptoms get noticeable 2-4 weeks after a strep A infection. Since the symptoms stem from an altered immune system rheumatic fever is not contagious. However, bacteria can spread strep A infection, triggering rheumatic fever. Rheumatic fever can be seen in people of any age. But, it is usually seen in children 5-15 years of age and is more prevalent in low socio-economic groups. Other risk factors include receiving an improper course of antibiotics, a prior history of rheumatic fever, and a history of repeated streptococcal infections. Testing for rheumatic fever includes throat swabs and blood tests. Initial and follow-up echocardiography may be needed to see the extent of valve damage.
Long-term complications of rheumatic fever involve the cardiovascular system. Symptoms are seen more commonly a decade or two after the first episode of rheumatic fever. This complication includes involvement of valves (mitral valves affected more commonly than aortic valves and stenosis more common than regurgitation), pulmonary hypertension, atrial fibrillation, heart failure, stroke, and rarely infection of valves (also called endocarditis). Symptoms usually start in the third to fourth decade and include shortness of breath, chest pain, palpitations, swelling in extremities, exertional tiredness, and rarely syncope.
Patients with a prior history of rheumatic fever are usually advised prophylaxis with injectable penicillin either till the age of 40 years or lifelong. This is done to prevent recurrent damage to valves causing risk of permanent damage and established rheumatic heart disease Management of RHD at initial stages includes penicillin prophylaxis and symptomatic treatment with cardiac drugs. Regular check-ups with cardiologists, blood thinning medications when needed, vaccination to prevent other infections, and maintaining dental hygiene and antibiotics before dental or surgical procedures are different ways to manage symptoms and prevent complications. Special precautions must be taken to treat rheumatic heart disease in pregnancy. However, if the patient remains symptomatic and develops a severe valve lesion, it may warrant interventional or surgical treatment. Interventional treatment is usually done for the mitral valve and involves balloon valvoplasty in appropriate patients. Patients with severe aortic valve lesions, mitral stenosis and unsuitable for angioplasty. After surgery, patients will be on lifelong anticoagulants (blood thinners) and other medications as per the symptoms.
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