Rheumatic heart disease
Also called: Rheumatic fever, RHD
Permanent heart valve damage caused by rheumatic fever — an immune reaction to an untreated streptococcal throat infection. Rare in wealthy countries, it still affects about 40 million people worldwide.
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What happens in the body
Antibodies against group A streptococcus cross-react with heart tissue (molecular mimicry), inflaming and scarring the valves, especially the mitral valve.
Causes
- Untreated group A streptococcal pharyngitis followed by rheumatic fever
Risk factors
- Children aged 5–15
- Overcrowding and poverty
- Limited access to antibiotics
Symptoms
- Acute rheumatic fever: fever, migrating joint pain, rash, jerky movements (Sydenham chorea)
- Later: breathlessness, palpitations, fatigue from valve disease
Diagnosis — tests and examinations
- Jones criteria for rheumatic fever
- Echocardiography
- Throat swab and antistreptolysin O titre
Treatment
Medicines and medical treatment
- Penicillin to clear streptococcus and long-term monthly benzathine penicillin to prevent recurrence
- Aspirin or NSAIDs for arthritis
- Heart failure and atrial fibrillation treatment
Operations and procedures
- Balloon mitral valvotomy
- Valve repair or replacement
Self-care, home remedies and lifestyle
- Never miss preventive penicillin injections
- Good dental care
Possible complications
- Mitral stenosis and regurgitation
- Heart failure
- Atrial fibrillation and stroke
- Endocarditis
Prevention
- Prompt antibiotic treatment of strep throat
- Secondary prophylaxis with penicillin
Outlook
Good if recurrences are prevented; established severe valve disease needs intervention.
When to see a doctor
Children with a sore throat and fever should be assessed; see a doctor for joint pains or breathlessness after a throat infection.
Sources and further reading
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