Why it is important to treat rheumatic heart disease with a sense of urgency?
Why it is important to treat rheumatic heart disease with a sense of urgency?
Introduction
In the lesser developed states of India, rheumatic heart disease is known to contribute to almost 40% of cardiac surgeries. This makes it important for the condition to be treated with a sense of urgency to prevent and control the high prevalence rates. It is estimated that in India the number of cases could touch a little above 3 million cases.
What is pulmonary heart disease?
This refers to a condition where the right side of the heart is enlarged and weakened. This is the result of high blood pressure in the lungs. As a result of this, pumping of blood through lungs from the right ventricle becomes extremely difficulty. This results in right-sided heart failure.
Main causes of pulmonary heart disease
- Pulmonary hypertension – due to lung diseases that afflict the pulmonary arteries.
- Chronic obstructive pulmonary disease – due to chronic bronchitis, obstructing flow of air and increased pressure in the lungs.
- Pulmonary embolism – blocked pulmonary arteries as a result of a blood clot.
- Interstitial lung diseases – that end scarring of lung tissue.
- Sleep apnea – resulting in intermittent increases in pulmonary pressure.
Commonly reported symptoms of pulmonary heart disease
- Difficulty breathing – during physical activity.
- Overall tiredness – as a result of reduced oxygen supply.
- Pain in the chest or discomfort – due to increased workload on.
- Swelling – in the legs, ankles, and abdomen.
- Jugular venous distension – swelling in the veins in the neck.
- Cyanosis – skin appears with a bluish tint, especially around lips and fingers.
How is pulmonary heart disease?
The condition is treated by managing existing conditions, oxygen therapy. Medications like diuretics, vasodilators, anticoagulants, bronchodilators, and changes in lifestyle are also part of treatment. In some cases, it may be necessary to undergo procedures like lung transplantation or pulmonary thromboendarterectomy.
What is rheumatic valvular heart disease?
This is a type of heart disease due to damage of the heart’s valves from rheumatic fever. The fever is itself an inflammatory condition that develops after strep throat infection from Group A Streptococcus bacteria. As a result of the immune response to the infection, inflammation is triggered in the heart and other parts of the body. This causes scarring and affects the heart valves. Rheumatic heart disease and rheumatic valvular heart disease are closely related.
The commonly valves affected in the condition include:
- Mitral valve – where the valve opening is narrowed or leakage occurs.
- Aortic valve – where there is narrowing of the aortic valve or backflow of blood.
Symptoms of rheumatic valvular heart disease
- Difficulty breathing.
- Overall tiredness.
- Irregular heartbeats.
- Pain in the chest or discomfort.
- Swelling in the legs.
- Coughing up blood.
How is the condition treated?
The condition is treated through medications to control symptoms, such as diuretics, anticoagulants, beta-blockers or calcium channel blockers. Surgical interventions may be necessary in some cases to repair or replace the damaged valves.
What is the best option for management of rheumatic heart disease
The management of rheumatic heart disease depends on the severity of the condition, and the affected heart valves. The purpose of treatment is to manage symptoms, and prevent complications, and is achieved by:
- Prevention of rheumatic fever – this could involve long term use of antibiotics as prophylactics.
- Symptomatic Treatment – with prescribed medicines, such as diuretics, beta-blockers, ACE inhibitors or ARBs, anticoagulants and anti-inflammatory drugs.
- Lifestyle changes – such as regular exercise, heart-healthy diet, quitting smoking, and managing weight.
- Surgery – such as valve repair or replacement. Valve repair is always a preferred option because it preserves the patient’s natural valve, helping maintains normal heart function. Valve replacement is necessary when repair is not an option. This involves replacement of the damaged valve either with a mechanical or biological valve. It is necessary to ensure anticoagulation management of mechanical valves for the remaining lifetime. Biological valves may need to be replaced after a certain period.
Tips for nursing management of rheumatic heart disease
This involves providing comprehensive care with a clear focus on managing symptoms, and preventing complications. Key tips for effective nursing management of rheumatic heart disease include the following.
Monitoring:
- Regularly monitor vital signs such as blood pressure, heart rate, respiratory rate, and oxygen saturation.
- Check for heart murmurs.
- Periodically assess the patient for difficulty breathing, pain in the chest, or overall fatigue. Look for signs of swelling in the legs or the abdomen.
- Observe signs of fluid retention, like enema or weight gain, and record urine output.
Medicines:
- Timely administration of medicines like diuretics, beta-blockers, anticoagulants, and antibiotics.
- Patients on anticoagulants are to be monitored for signs of bleeding.
During surgeries:
- Ensure that the patient receives preoperative care when surgery is required.
- Post-surgery, monitor the patient for any indications of complications like infections, bleeding, or arrhythmias.
Complications:
- Ensure that complications like heart failure are managed by actions like inclining the bed to handle shortness of breath.
- Prevent infections, through proper oral care, and hygiene.
- Ensure long-term antibiotic prophylaxis.
What is the role of genetic testing in rheumatic valvular heart disease?
While the role of genetic testing in rheumatic valvular heart disease is limited, it is continually increasing. This is due to applications that have immense potential in the future. The role of genetic testing facilities in the future will include the following:
- Genetic predisposition – with advanced genetic testing it is possible to determine genetic factors that have an influence on a person’s risk of developing rheumatic valvular heart disease. As a result of genetic variations, the immune responses differ, and some people may be genetically predisposed.
- Family history – genetic testing could possibly identify people with higher risk as a result of inherited genetic components.
- Personalized medicine – a futuristic possibility is that genetic testing can help assess a person’s risk of developing severe RVD. Based on this risk assessment, it would be possible to work out preventive measures at a personalized level.
- Counseling – this can help individuals with a family history of RVD. Counselling can offer information on the risk for future generations in the family.
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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).