Your child and rheumatic heart disease
While it’s not often seen in private practice, rheumatic heart disease is one of the most commonly acquired childhood heart diseases around the world, affecting about 325 000 children each year. Dr Enrico Maraschin, a paediatrician at Mediclinic Morningside, discusses the chain of events that precede it and how to prevent it.
Rheumatic heart disease is a complication of rheumatic fever, in which the heart valves are damaged. Worldwide there are around 18 million people living with rheumatic heart disease, says Dr Maraschin. What’s more, rheumatic heart disease is often undiagnosed, especially in poverty-stricken areas.
‘A recent study in an underprivileged community in Cape Town revealed that 20 to 30 children per 1 000 suffer from rheumatic heart disease despite being well and unaware of their condition at the time of the study,’ says Dr Maraschin.
Rheumatic heart disease begins with something as seemingly routine as a sore throat, which underscores the importance of taking your children to the doctor when they’re unwell.
‘Rheumatic heart disease is not something that a child “catches”, rather it’s the end point of an accumulation or chain of events,’ explains Dr Maraschin.
Here he explains the signs and symptoms en route to rheumatic heart disease:
1. It all begins with an untreated bacterial sore throat. The bacteria, in this case, is group A streptococcus.
2. Rheumatic fever may develop two to four weeks after an untreated sore throat with symptoms of tiredness, poor appetite, weight loss, fever, joint pain, skin rash and even heart failure – a serious condition in which the heart cannot pump blood around the body efficiently – which presents with coughing, shortness of breath and swelling of the body.
A possible further complication is a brain disorder, which occurs more commonly in girls, and will cause the child to be emotionally upset, clumsy, fidgeting or have abnormal movements.
3. Rheumatic fever can occur in up to 3% of cases with untreated group A streptococcal infection. Certain people are genetically more predisposed to developing rheumatic fever, and other contributing factors are malnutrition and poverty. ‘Rheumatic fever occurs most often between the ages of 5 and 15 years,’ says Dr Maraschin, although it can also affect adults and younger children.
4. An untreated sore throat causes the formation of antibodies that can attack various organs. In rheumatic heart disease these antibodies attack the valves of the heart and can result in heart failure.
5. Should a child suffer from repeated untreated throat infections and subsequent rheumatic fever, further attacks on the heart occur, leading to a worsened condition.
Prevention and treatment
Parents should never feel they’re being neurotic or overreacting, says Dr Maraschin, especially when something as simple as a sore throat can lead to a life-changing condition.
‘It’s vital for parents to understand that rheumatic fever and subsequent rheumatic heart disease is preventable,’ he stresses. ‘If a child develops a sore throat it’s important to establish the cause. A bacterial infection must be treated with an antibiotic. Since it’s not always possible to determine whether the sore throat is viral or bacterial, caution should be exercised and appropriate antibiotic treatment administered.
‘Should the child have suffered rheumatic fever or rheumatic heart disease, it’s imperative that bacterial sore throats be prevented for the rest of the child’s life since the effects of repeated infections are cumulative and the heart can continue to be harmed,’ Dr Maraschin explains. ‘Once the course of events from sore throat to heart disease has begun, the child is required to be on life-long antibacterial treatment. Antibiotics are given either orally or by injection into a muscle.
‘Heart involvement will require bed rest and anti-heart failure therapy. In some cases, the child may require surgery to repair the damaged heart valves. Should there be any brain involvement during the disease, antipsychotic treatment will be required,’ he adds.
When in doubt, always consult your doctor. ‘Early detection and management of group A streptococcus has resulted in a very low occurrence of rheumatic heart disease in private practice,’ Dr Maraschin concludes.