Is it possible to prevent rheumatic heart disease?
Is It Possible To Prevent Rheumatic Heart Disease?
- Introduction
- What Is The Timeline For Onset And Progression Of Rhd Heart Disease?
- What Is The Most Effective RHD Heart Disease Treatment?
- What Symptoms Can Be Called As Rheumatic Heart Disease Criteria?
- What Is The Main Rheumatic Heart Disease Causative Agent?
- What Are The Critical Or Main Rheumatic Heart Disease Complications?
- Is It Possible To Detect RHD Through Genetic Testing?
Introduction
Technically, it is possible to prevent rheumatic heart disease as the cause of the condition is strep infections. By preventing the onset of strep infections, or completely treating the infection, it is possible to prevent RHD. However, this may be challenging in some situations as it requires monitoring and medications on a long term basis. Here is a good look at RHD, diagnostic criteria, timeline and treatment options.
What Is The Timeline For Onset And Progression Of Rhd Heart Disease?
Rheumatic heart disease begins with the initial Group A Streptococcus infection and concludes with development of heart disease. Here is the typical timeline of rheumatic heart disease:
- Streptococcal infection (days 0-14) – This begins with the patient contracting streptococcal infection, developing either as strep throat or skin infection. Possible symptoms include sore throat, fever, and swollen lymph nodes.
- Infection left untreated (1-3 weeks) – When the streptococcal infection is not treated with antibiotics, rheumatic fever disease risk increases. The symptoms of infection subside, while the immune system starts to react to the bacteria.
- Rheumatic fever (2-6 weeks post infection) – Onset of rheumatic fever typically occurs 2-4 weeks after the initial infection. Possible symptoms include inflammation of the heart, pain in the joints and possible swelling, involuntary movements and outbreak of rashes and subcutaneous nodules.
- Heart Valve Damage (after rheumatic fever) – Post rheumatic fever, the heart valves undergo damage over many weeks. Possible symptoms of heart disease include difficulty breathing, pain in the chest, overall fatigue, and swelling in the feet.
- Rheumatic Heart Disease – This occurs overs months or possibly years, as a result of the chronic inflammation, causing scarring and deformity of the heart valves. Severity of rheumatic heart disease include heart failure, arrhythmias and infective endocarditis.
What Is The Most Effective RHD Heart Disease Treatment?
Treatment focuses on managing symptoms, and preventing complications. The goal of rheumatic heart disease treatment is handling the underlying rheumatic fever, and effective treatment approaches include:
- Antibiotic medications – like penicillin are administered on a long-term basis to prevent recurrent rheumatic fever.
- Heart failure symptoms – are managed with medications to relieve symptoms and improve heart function. Medicines include diuretics, ACE inhibitors, beta-blockers and aldosterone antagonists.
- Anti –inflammatory medicines like non-steroidal anti-inflammatory drugs or corticosteroids are given to reduce inflammation in the heart.
- Surgery – is required in cases where there is considerable valve damage. This could be either valve repair or replacement.
- Lifestyle changes – are necessary to reduce risk and prevent complications. This includes consumption of a balanced diet, doctor approved physical activity, quitting smoking, limiting alcohol intake and weight management.
What Symptoms Can Be Called As Rheumatic Heart Disease Criteria?
The Revised Jones Criteria helps in identifying rheumatic fever, resulting in rheumatic heart disease. Major criteria with respective symptoms include the following:
- Carditis with symptoms like inflammation of the heart, heart murmurs, pain in the chest, difficulty breathing, palpitations and overall fatigue. The patient may experience swelling in the feet, or abdomen as a result of heart failure.
- Polyarthritis with symptoms like migratory arthritis that affects large joints such as the knees, ankles, elbows. This causes swelling, pain, reddish appearance and affects mobility.
- Chorea with symptoms like involuntary, sudden movements affecting the limbs, face and speech.
- Erythema marginatum is a type of rash causing pink or red rings on the trunk and inside portions of limbs. These rashes are not known to cause any itching sensation.
- Subcutaneous nodules are painless lumps that form over bony areas or over tendons, indicating severe rheumatic fever.
What Is The Main Rheumatic Heart Disease Causative Agent?
One of the main or primary reasons for rheumatic heart disease is infection from Group A Streptococcus bacteria. The timeline and progression of the disease from infection is explained above. Treatment with antibiotics can prevent rheumatic fever and rheumatic heart disease. This is necessary for patients and populations with a history of rheumatic fever.
What Are The Critical Or Main Rheumatic Heart Disease Complications?
Various complications arise as a result of rheumatic heart disease. This is mainly due to the damage of the heart valves as a result of inflammation. Let us take a quick look at the main complications arising from RHD:
Damage to the heart valves:
- Mitral valve stenosis – refers to narrowing of the mitral valve, causing restricted flow of blood from the left atrium to the left ventricle.
- Mitral valve regurgitation – refers to leakage of blood into the left atrium, as a result of improper closure of mitral valve.
- Aortic valve stenosis – refers to narrowing of the aortic valve, restricting flow of blood from the left ventricle to the aorta.
- Aortic valve regurgitation – refers to flow of blood back from the aorta to the left ventricle, resulting in overload and weakening of the heart.
- Heart failure – is a possible outcome due to damage to the heart valves, making the heart unable to pump blood effectively. Symptoms include difficulty breathing, overall fatigue, and swelling in the feet.
- Arrhythmias – is due to the inflammation of the heart, affecting normal electrical pathways. These irregular heartbeats can be life-threatening at times.
- Infective endocarditis – is due to damaged heart valves that are prone to bacterial infections. Infective endocarditis is a serious infection that can damage the valves and spread across other organs.
- Thromboembolic events – refers to turbulent flow of blood as a result of valve dysfunction. This can considerably increase the risk of formation of blood clots, that may dislodge resulting in strokes or pulmonary embolisms.
- Progressive heart disease – occurs over time, with RHD affected individuals experiencing worsening heart function. This aggravated condition and its complications require intensive treatments or possible surgical interventions.
Is It Possible To Detect RHD Through Genetic Testing?
No, genetic testing has a different purpose and is used for detecting genetic mutations or certain inherited conditions. These tests help to determine if the person is at risk of developing heart diseases in the future or over a lifetime. RHD is due rheumatic fever and therefore cannot be detected with genetic testing.
It is however, advisable to undergo genetic testing to look for other genetic risk factors that may complicate RHD. Saliva or blood samples are analyzed to look for genetic component of heart disease and risk.
Related Blogs :
Shetty B s a cardiologist in Chennai, with extensive experience in the field. He completed his MBBS from Madurai Kamaraj University, followed by an MD in General Medicine and a DM in Cardiology from The Tamil Nadu Dr. M.G.R. Medical University (TNMGRMU).