Rheumatic Heart Disease (RHD)

 

Rheumatic Heart Disease (RHD)

 

Introduction:

The dangerous disorder known as rheumatic heart disease (RHD), which affects the heart valves, is sometimes brought on by an untreated or ineffectively treated streptococcal throat infection. Although rheumatic heart disease (RHD) is avoidable and has been virtually eradicated in wealthy nations, it still has a considerable negative impact on global health in many regions. The goal of this blog is to give a thorough review of rheumatic heart disease (RHD), covering its definition, causes, types, phases, symptoms, diagnostic standards, research, and available treatments.

Definition:

Rheumatic Heart Disease is a chronic condition that occurs as a consequence of Rheumatic Fever (RF), an inflammatory disease that affects various connective tissues in the body. RF is caused by an abnormal immune response to a streptococcal infection, primarily affecting the throat. If left untreated or poorly managed, RF can lead to progressive damage to the heart valves, resulting in Rheumatic Heart Disease.

Causes:

Group A streptococcal bacteria are predominantly responsible for rheumatic heart disease. The body's immune system may wrongly target healthy tissues, such as those in the heart, joints, and skin, in those who have untreated or ineffectively treated streptococcal throat infections. Although the precise mechanism of this immune response is yet unknown, molecular mimicry is thought to play a role. In this scenario, the immune system of the body incorrectly recognizes its own tissues as foreign and mounts an immune reaction against them.

Types of Rheumatic Heart Disease:

Rheumatic heart disease comes in a wide range of types depending on which heart valves are impacted. These consist of:

1. Mitral Valve Stenosis: The mitral valve, which regulates blood flow between the left atrium and the left ventricle, narrows in the most common type of rheumatic heart disease (RHD).
2. Mitral Valve Regurgitation: Blood flows backward from the left ventricle to the left atrium as a result of the mitral valve failing to close properly.
3. Aortic Valve Stenosis: Aortic valve narrowing, which regulates blood flow from the left ventricle to the aorta, is one of its main characteristics.
4. Aortic Valve Regurgitation: The aortic valve malfunctions in this situation, allowing blood to flow backward from the aorta to the left ventricle.

Stages of Rheumatic Heart Disease:

Rheumatic heart disease (RHD) typically progresses through four stages:

1. Acute Rheumatic Fever: The heart, joints, and skin are among the tissues that are inflammatory in this initial stage. Fever, joint pain, rash, and swollen joints are possible symptoms.
2. Asymptomatic rheumatic heart disease (RHD): In this stage, despite the absence of obvious symptoms, heart valve disorders may still be present in certain patients.
3. Symptomatic rheumatic heart disease (RHD): As the heart valves sustain severe damage, symptoms like shortness of breath, tiredness, chest pain, and palpitations may occur.
4. Severe rheumatic heart disease (RHD): At this advanced stage, Heart failure, arrhythmias, and other issues could develop and call for immediate medical intervention.

Signs and Symptoms:

Depending on the type and degree of valve impairment, the signs and symptoms of rheumatic heart disease can change. Typical signs could include:

• Shortness of breath, especially during physical exertion
• Fatigue and weakness
• Chest pain or discomfort
• Rapid or irregular heartbeat
• Swelling of the legs, ankles, or abdomen
• Fainting or dizziness
• Unexplained weight gain

Diagnostic Criteria:

Diagnosing Rheumatic Heart Disease Clinical evaluation, medical history, and a variety of diagnostic tests, including as:

• Thorough physical examination, including listening to the heart for murmurs or abnormal sounds
• Reviewing symptoms and medical history, particularly episodes of streptococcal infection or rheumatic fever
• Blood tests to check for markers of inflammation and evidence of previous streptococcal infection
• Echocardiogram to assess the structure and function of the heart valves
• Electrocardiogram (ECG) to detect any abnormalities in heart rhythm

Investigation:

Additional tests may be necessary to determine the severity of rheumatic heart disease and the extent of valve damage, such as:

• X-ray of the chest to check the heart and lungs
• Cardiac MRI or CT scan for detailed imaging of the heart valves and surrounding structures
• Exercise stress test to figure out heart health when exercising
• Transesophageal echocardiogram (TEE) for a more detailed assessment of the heart valves using a specialized probe inserted through the esophagus

Treatment:

In order to manage symptoms, stop further damage to the heart valves, and lower the likelihood of complications, rheumatic heart disease is treated. The options for treatment could consist ofs:

• Antibiotics: Antibiotic therapy, to get rid of any leftover streptococcal infection and stop subsequent attacks of rheumatic fever, medications like penicillin are administered.
• Anti-inflammatory medications: To decrease inflammation and improve symptoms, corticosteroids or nonsteroidal anti-inflammatory medications (NSAIDs) may be utilized.
• Medications for heart failure and arrhythmias: Heart failure medications like beta-blockers or diuretics may be recommended in cases of significant valve damage. In some circumstances, anticoagulants may also be required to avoid blood clots.
• Surgical interventions: To enhance heart function and restore normal blood flow in severe situations, damaged heart valves may need to be surgically repaired or replaced.

Preventions of Rheumatic Heart Disease (RHD)

Addressing the underlying causes and lowering your chance of getting the streptococcal infections that can cause rheumatic heart disease (RHD) are two ways to prevent it. Here are some precautions to take:

1. Promptly treat streptococcal infections: Strep throat, a streptococcal throat infection, should be identified early and treated right away with the necessary medications. To guarantee that the bacteria are completely eradicated, the entire course of antibiotics must be taken.
2. Antibiotic prophylaxis: Long-term antibiotic prophylaxis may be advised for people who have had an episode of acute rheumatic fever or have already suffered heart valve damage. To achieve this, consistent antibiotic use is necessary to guard against streptococcal infections and the consequent onset of rheumatic fever.
3. Improved hygiene practices: Promoting hygienic habits like routine hand washing with soap and water can help stop the spread of streptococcal bacteria. This is particularly critical in crowded situations like schools and hospitals.
4. Strengthening healthcare systems: For the early identification and efficient therapy of streptococcal infections, it is essential to ensure access to high-quality healthcare, especially in underprivileged areas. This includes raising awareness of the symptoms, risks and warning indications of rheumatic heart disease (RHD) and streptococcal infections among the general public and among healthcare professionals.
5. Public health initiatives: Rheumatic heart disease (RHD) and its prevention can be made more widely known by implementing public health efforts, such as neighborhood-based programmes and educational campaigns. These programmes could emphasise encouraging healthy habits, early streptococcal infection identification and treatment, and adherence to recommendations for antibiotic prophylaxis.
6. Vaccination: Vaccination against some strains of streptococcal bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae type B, can help lower the overall burden of respiratory infections and indirectly lower the risk of rheumatic fever even though there is currently no vaccine available specifically for rheumatic heart disease (RHD).
7. Health promotion and education: rheumatic heart disease (RHD) must be prevented through educating individuals, families, and communities. This entails raising knowledge of the value of getting prompt medical attention for streptococcal infections, finishing any prescribed antibiotic regimens, and being aware of the long-term effects of untreated or improperly managed streptococcal infections.

A multifaceted strategy involving individual actions, improvements to the healthcare system, and community-based activities is needed to prevent rheumatic heart disease (RHD). We can dramatically lower the prevalence of rheumatic heart disease (RHD) and enhance the general cardiovascular health of susceptible people by putting these preventive approaches into practice. 

Conclusion:

The majority of those affected by rheumatic heart disease live in areas with poor access to healthcare, making it a serious yet preventable global health problem. For successful management of rheumatic heart disease (RHD) and detect it early, it is essential to understand its causes, types, stages, signs and symptoms, diagnostic criteria, examinations, and treatment choices. By raising awareness and putting effective prevention measures into practice, we can work to lessen the burden of rheumatic heart disease and enhance the general cardiovascular health of those affected all over the world.

 

Dr.Muhammad Arsalan Khan
MBBS, DHHM, MSc (D & E)
CCD-BMJ-AKU-RCP (London)