RHEUMATIC HEART DISEASE

Overview & Facts

Rheumatic heart disease describes a group of short-term (acute) and long-term (chronic) heart disorders that can occur as a result of rheumatic fever. Rheumatic fever is an inflammatory disease that may affect many connective tissues of the body, especially those of the heart, joints, brain or skin. It usually starts out as a strep throat (streptococcal) infection. Anyone can get acute rheumatic fever, but it usually occurs in children between the ages of 5 and 15 years. About 60% of people with rheumatic fever develop some degree of subsequent heart disease.

One common result of rheumatic fever is heart valve damage, particularly scarring of the heart valves, forcing the heart to work harder to pump blood. The damage may resolve on its own, or it may be permanent, eventually causing congestive heart failure (CHF). CHF is a condition in which the heart cannot pump out all of the blood that enters it, which leads to an accumulation of blood in the vessels leading to the heart and fluid in the body tissues.

Types & Symptoms

The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage. These include:

  • Chest pain
  • Excessive fatigue
  • Heart palpitations (when the heart flutters or misses beats)
  • A thumping sensation in the chest
  • Shortness of breath
  • Swollen ankles, wrists or stomach

Diagnosis & Medications

DIAGNOSIS

The first step in diagnosing rheumatic heart disease is establishing that your child recently had a strep infection. The doctor may order a throat culture, a blood test, or both to check for the presence of strep antibodies.

The doctor will do a physical examination and check your child for signs of rheumatic fever, including joint pain and inflammation. The doctor also will listen to your child’s heart to check for abnormal rhythms or murmurs that may signify that the heart has been strained.

The doctor may order a couple of tests to check the heart and assess damage, including:

  • Chest X-ray to check the size of the heart and to see if there is excess fluid in the heart or lungs
  • Echocardiogram, a non-invasive test that uses sound waves to create a moving image of the heart and to measure its size and shape

 

TREATMENT

The doctor will customize treatment based on:

  • Your child’s overall health and medical history
  • Extent of the disease
  • Your child’s tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

The best treatment for rheumatic heart disease is prevention. Antibiotics can usually treat strep throat and stop acute rheumatic fever from developing.

Children who have previously contracted rheumatic fever are often given continuous (daily or monthly) antibiotic treatments to prevent future attacks of rheumatic fever and lower the risk of heart damage.

If inflammation of the heart has developed, children may be given medications to reduce the inflammation, as well as antibiotics to treat the Streptococcus infection. Other medications may be necessary to handle congestive heart failure.

If heart valve damage occurs, surgical repair or replacement of the valve may be considered.

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