Rheumatic heart disease

Rheumatic heart valve disease is the main cause of heart failure among children and young people presenting in hospitals. It causes 400,000 deaths worldwide annually, mainly among children and young adults living in developing countries.

The three countries in the world where the largest number of lives are claimed by rheumatic heart disease are Egypt, Brazil and India. Many people who live in remote areas have some of the highest rates in the world.

However, many cases are never diagnosed or reported.

Because rheumatic heart disease affects mainly the poor, it is often neglected by researchers, health educators and the media. 

What, exactly, is rheumatic fever?
Rheumatic fever is a serious immune disease which primarily affects children aged five to 15 years. The disease can cause inflammation and damage to several parts of the body, particularly the heart, joints and central nervous system.

The most common heart problem associated with rheumatic fever is heart-valve damage.

Between 40% and 60% of patients develop heart inflammation with their first attack of rheumatic fever, and this often results in permanent scarring of the heart valves, particularly the mitral valve. A scarred heart valve may prevent adequate blood flow or cause backward flow of blood. Damage to the heart valves may only show up 10 to 30 years after the initial infection.

Other heart problems that may develop are endocarditis (an inflammation of the lining of the heart), heart failure as a result of inflammation of the heart muscle, arrhythmias or abnormal heart rhythms, and pericarditis (an inflammation of the sac surrounding the heart).

Treatment of rheumatic heart disease is expensive and complicated. In advance stages it could involve the replacement of heart valves. The high cost of valves is however often prohibitive. As a result, many people in developing countries die while waiting for an operation. Even the lucky ones who do undergo surgery, may require further operations and are at risk for developing further heart problems.

These cases can be prevented easily and cheaply if antibiotics are administered to prevent its cause, rheumatic fever.

What causes rheumatic fever?
The exact cause of rheumatic fever is not yet known, but it occurs within one to five weeks after an infection with untreated group A streptococcus, the bacterium that causes "strep throat" and scarlet fever.

In some people, it appears that the body's immune system becomes overactive in its response to the streptococcus bacterium. This overreaction leads to inflammation and tissue damage in the heart and other parts of the body.

Spot the symptoms
Often parents don’t know that there is a connection between a sore throat and heart disease in children and it is advisable that all children with a sore throat, and who do not have a runny nose, see a doctor as soon as possible.

Prompt and effective treatment of streptococcal infection with antibiotics will usually prevent rheumatic fever developing, and also reduces the risk of streptococcus being transmitted to other people.

People who have already had rheumatic fever are more susceptible to further attacks. Such people need long-term antibiotic treatment to prevent rheumatic heart disease.

Since there is no vaccine against Group A strep available or “anywhere near human study status”, according to microbiologist Dr Andrew Whitelaw, early diagnosis and effective treatment are of the utmost importance.

If you suspect that someone has rheumatic fever, seek treatment immediately. Look out for the following symptoms:

• Fever
• Joint pain, which often moves from joint to joint
• Joint swelling, which may be accompanied by redness and a sensation of heat
• Abdominal pain
• Vomiting
• Skin rash: broad, pink to light-red patches that increase in size and do not itch
• Small lumps under otherwise normal-looking skin
• Unusual, involuntary jerky movements
• Muscle pain
• Confusion
• Decreased muscle tone
• Shakiness of one or more parts of the body
• Speech difficulties
• Coughing
• Fatigue and weakness
• Heart palpitations
• Chest pain

These symptoms usually appear about two to four weeks after an untreated streptococcal infection. 

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