Rheumatic Heart Disease (RHD)

Introduction

Rheumatic Heart Disease (RHD) is a chronic condition resulting from acute rheumatic fever (ARF), an inflammatory reaction to untreated or inadequately treated streptococcal throat infection.

Causes and Pathophysiology

  • Acute Rheumatic Fever (ARF): Triggered by Group A Streptococcus (GAS) infection.
  • Autoimmune Reaction: The immune system mistakenly attacks heart valves, leading to fibrosis and scarring over time.
  • Valve Damage: Primarily affects the mitral valve, leading to stenosis (narrowing) or regurgitation (leakage).

Symptoms

  • Shortness of breath
  • Fatigue
  • Chest pain
  • Palpitations
  • Swelling in the legs

Diagnosis

  • Echocardiography: Gold standard for detecting valve damage.
  • Electrocardiogram (ECG): Detects associated arrhythmias.
  • Blood Tests: Look for inflammatory markers (ESR, CRP).
  • Throat Cultures: Identify Group A Streptococcus.

Treatment and Prevention

  • Antibiotic Prophylaxis: Long-term penicillin injections to prevent recurrence.
  • Anti-inflammatory Medications: Aspirin or corticosteroids for acute inflammation.
  • Surgical Interventions: Valve repair or replacement in severe cases.
  • Public Health Measures: Improve access to healthcare, early antibiotic treatment for streptococcal infections, and vaccination research.

Conclusion

Early detection and long-term management of rheumatic fever can prevent the progression to RHD, reduce complications, and improve quality of life.

Source recommendations

1. American Heart Association Guidelines on Rheumatic Fever and Rheumatic Heart Disease

  1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000921
  2. https://pubmed.ncbi.nlm.nih.gov/17446442/
  3. https://www.ahajournals.org/doi/10.1161/cir.0000000000000205
  4. https://professional.heart.org/en/science-news/contemporary-diagnosis-and-management-of-rheumatic-heart-disease
  5. https://www.aafp.org/pubs/afp/issues/2010/0201/p346.html

2. European Society of Cardiology Guidelines on Infective Endocarditis and Rheumatic Heart Disease

  1. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Indications-for-antibiotic-prophylaxis-to-prevent-infective-endocarditis-in-adults
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
  3. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/vol16no33
  4. https://www.ahajournals.org/doi/10.1161/cir.0000000000000296
  5. https://academic.oup.com/eurheartj/article/36/44/3075/2293384

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