Introduction

Rheumatic heart disease results from permanent heart valvedamage caused by rheumatic fever, an autoimmune condition that causes an ongoing diffuse inflammatory disorder of connective tissue, including the heart valves. It is a preventable but serious public health issue primarily affecting children aged 5 to 15 years living in developing countries with limited access to health care.

Causes

It’s caused by inadequately treated Group A streptococcal tonsillopharyngitis. Children who suffer multiple episodes of strep pharyngitis are at high risk of developing rheumatic fever, which can progress to rheumatic heart disease later in life. The heart valves are initially inflamed and then scarred over time, causing the valve to narrow or widen and impair the heart’s ability to pump blood effectively.

Signs and Symptoms

Signs and symptoms of rheumatic fever begin 1-2 weeks following a strep throat infection and include.

• Fatigue
• Fever
• Joint pain with or without swelling and redness
• A rash with pink rings and a clear center called erythema marginatum
• Uncontrolled jerky hand movements called Sydenham’s chorea 
• Painless nodules under the skin near joints

If it doesn’t resolve at this stage, it might progress to rheumatic heart disease, and depending on the degree of heart valve damage, it may cause symptoms of heart failure such as 

• Chest pain
• Shortness of breath
• Swelling of the stomach, hands, and feet due to fluid accumulation, 
• Fatigue
• Rapid, irregular heartbeat

Diagnosis

The diagnosis of rheumatic fever is made using Jones criteria, which include the above signs and symptoms, a preceding history of strep throat infection, abnormal heart sounds called murmurs, laboratory test results, and ECG and ECHO findings. A diagnosis of rheumatic heart disease is made when there is a preceding episode of rheumatic fever with a permanent chronic valve disease confirmed by ECHO.

Treatment 

Treatment of rheumatic fever consists of antibiotic therapy, anti-inflammatory therapy, heart failure management, and ongoing care for secondary prevention. 

There are no curative treatment options for rheumatic heart disease, but valvular surgery, influenza vaccination, dental hygiene, and prophylaxisagainst cardiac infection are some of the indications to prolong life.

Prevention 

Prevention is accomplished through early diagnosis and adequate antibiotic treatment of strep pharyngitis. In patients who have already developed rheumatic fever, continuous antimicrobial prophylaxis for a certain duration of time is indicated to prevent acquiring rheumatic heart disease.

Conclusion 

Rheumatic heart disease is a permanent and fatal consequence of rheumatic fever, which predominantly affects children living in low- to middle-income countries. It results from insufficient treatment ofstreptococcal pharyngitis. Antibiotic therapy can prevent it from progressing to the stage of rheumatic heart disease. So, health education and the provision of access to health care in developing countries are crucial to addressing this easily preventable yet serious public health issue.