Am I at risk for rheumatic heart disease?

Posted on 2 August 2022

Unlike heart disease associated with lifestyle conditions, such as high cholesterol and obesity, rheumatic heart disease stems from infection and can strike anyone. A Mediclinic cardiologist explains what you need to know. 

Rheumatic heart disease is a dangerous condition and, according to Professor Danie Marx, a cardiologist at Mediclinic Bloemfontein, it’s more prevalent in developing countries, with limited access to health services – like many parts of South Africa.   

“Rheumatic heart disease is an inflammatory disease of the heart valve that comes about from a streptococcal infection – usually tonsilitis or pharyngitis,” explains Professor Marx. “If not treated appropriately, the infection leads to acute rheumatic fever, which can then develop into chronic rheumatic fever. This initiates an immune response, which can affect the heart.”  

Chronic rheumatic heart disease occurs when the infection has passed, but the heart valves have been damaged, Professor Marx explains. The heart valve may have narrowed or it can be incompetent and leak. If left undiagnosed, an incompetent, leaking heart valve could put you at risk of severe infection and rheumatic heart disease can also lead to heart failure. 

If you have acute rheumatic fever, you still have an active streptococcal infection. Professor Marx says symptoms will include a fever, as well as arthritic joint pain that moves from joint to another. When acute rheumatic fever affects the heart, it’s called carditis – and symptoms will vary, depending on which part of the heart is affected. 

Pericarditis: Is when it affects the outer wall. Patients will usually experience chest pain.  

Endocarditis: Is when it affects the heart valves. In this case, there will be a heart murmur. 

Myocarditis: Is when it affects the heart muscle. You will have shortness of breath and start showing early signs of heart failure. 

When it affects all three layers of the heart, it’s called pancarditis. 

Other symptoms of rheumatic fever may include Sydenham chorea – a neurological disorder that mainly affects girls, where they will experience unplanned spasmodic movements of the arms and legs, similar to restless leg syndrome – and skin lesions.  

Chronic rheumatic heart disease may be asymptomatic aside from a heart murmur, which may only be picked up during an examination for something else. “We often pick up the murmur in young women when they’re pregnant and going for their routine exams,” says Professor Marx. “If this is the case, first thing we look for is rheumatic heart disease.” 

Rheumatic fever – and by extension, rheumatic heart disease – is most common in situations where many people are in close proximity because streptococcus is airborne and more easily transmitted under these conditions. They include crowded living conditions, such as informal settlements, as well as gathering places like schools and universities. This is why acute rheumatic fever is more often seen in younger people of school-going and university age. It’s also generally accepted in medical circles that rheumatic heart disease is more common in women than in men, Professor Marx says. 

If your doctor suspects you have rheumatic fever based on a clinical examination, they can confirm the diagnosis with a throat swab or blood tests. It’s important to treat the underlying streptococcal infection thoroughly with antibiotics to ensure that it doesn’t flair up again. Simultaneously, your doctor will give you supportive treatments to ease the symptoms – such as pain relief if you have chest pain, says Professor Marx. If you have chronic rheumatic heart disease, treatment will depend on the nature of your condition. Medication will be the first port of call for a compromised valve, but if it doesn’t respond, you may need surgery. If your valves are narrowed, your doctor may recommend mechanical therapy to open them, using balloon dilation. 

Rheumatic heart disease is caused by an underlying infection that causes the problem in the first place, says Prof Marx. “To prevent developing this disease, if you have tonsilitis or pharyngitis, treat it quickly and treat it well.” 

Published in Cardiology

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