rheumatic heart disease

Rheumatic heart disease (RHD) is a condition where the heart valves have been permanently damaged by rheumatic fever, leading to changes in the myocardium or scarring of the heart valves that reduce the power of the heart to pump blood.

Causes and Effects

• RHD starts as a sore throat from a bacterium called Streptococcus pyogenes (group A streptococcus) which can pass easily from person to person [1].
• The condition is a systemic immune process that is sequelae to a beta-hemolytic streptococcal infection of the pharynx [3].
• RHD results from damage to heart valves caused by one or several episodes of rheumatic fever, leading to long-term damage to the heart and its valves [7].

Characteristics

• The heart valve damage may start shortly after an untreated strep infection, leading to a condition where the heart valves have been permanently damaged [5].
• RHD is characterized by changes in the myocardium or scarring of the heart valves that reduce the power of the heart to pump blood [10].

Symptoms and Consequences

• The symptoms of RHD can vary depending on the severity of the valve damage, but may include shortness of breath, fatigue, and swelling in the legs.
• If left untreated, RHD can lead to serious complications such as heart failure, arrhythmias, and even death.

References

[1] Context result 1 [3] Context result 3 [5] Context result 5 [7] Context result 7 [10] Context result 10

Rheumatic heart disease (RHD) can manifest in various ways, and its symptoms may not always be immediately apparent. However, there are several common signs and symptoms associated with RHD that can help with diagnosis.

Common Signs and Symptoms:

• Chest pain or discomfort [8]
• Shortness of breath [8][12]
• Swelling of the stomach, hands, or feet [8][6]
• Heart palpitations [5][12]
• Excessive fatigue [5][12]
• Trouble breathing [6]

Other Possible Symptoms:

• Fever [9][12]
• Joint swelling, tenderness, or redness over multiple joints [9][3]
• Small bumps or nodules under the skin [9]
• Rash [9]
• Weight loss [9]
• Fatigue [9]
• Stomach pain [9]

Important Note:

It's essential to note that some people with RHD may not experience any symptoms at all, especially in the early stages of the disease. If you suspect you or someone else has RHD, it's crucial to consult a healthcare professional for proper evaluation and diagnosis.

References:

[3] Signs and symptoms of rheumatic fever [5] Rheumatic Heart Disease Signs and Symptoms [6] What are the symptoms of rheumatic heart disease in a child? [8] Signs & Symptoms [9] Fever · Joint swelling, tenderness or redness over multiple joints · Small bumps or nodules under the skin · Rash · Weight loss · Fatigue · Stomach pain. [12] Rheumatic heart disease is a condition where the heart valves have been permanently damaged by rheumatic fever, an inflammatory disease caused by untreated or undertreated strep infections. Symptoms may include fever, joint pain, rash, shortness of breath, chest pain

Rheumatic heart disease (RHD) can be diagnosed through various diagnostic tests, which help identify the condition and its severity. Here are some common diagnostic tests used to diagnose RHD:

• Echocardiogram: This test uses sound waves to create images of the heart's chambers and valves. It can assess the heart valves and look for signs of heart failure [7]. An echocardiogram is usually the first imaging test used to diagnose RHD.
• Electrocardiogram (ECG): This test measures the electrical activity of the heart, which can help identify any abnormalities in the heartbeat. While an ECG is not specific to RHD, it can be helpful in the initial assessment of patients with suspected RHD [5].
• Blood tests: Blood tests can be done to check for signs of inflammation in the body, such as elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels. These tests are not specific to RHD but can help confirm a diagnosis and monitor disease activity [4].
• Throat culture: A throat culture can be done to check for streptococcal infections, which can lead to rheumatic fever and subsequent RHD.
• Imaging tests: In addition to echocardiography, other imaging tests such as chest radiographs (X-rays) may also be used to assess the heart's size and shape.

It is worth noting that there is no definitive diagnostic test for acute rheumatic fever, and a clinical diagnosis is often made using the Jones criteria [3].

Treatment Options for Rheumatic Heart Disease

Rheumatic heart disease (RHD) requires a comprehensive treatment approach to manage the condition and prevent further complications. The primary goal is to alleviate symptoms, slow disease progression, and improve quality of life.

• Anti-inflammatory medications: Aspirin, steroids, or nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce inflammation and alleviate pain [1].
• Penicillin injections: People at risk of RHD may need penicillin injections every three to four weeks for five or more years or lifelong, depending on the degree of heart involvement [3].
• Antibiotics: Rheumatic fever is treated with antibiotics, such as penicillin or another antibiotic, to kill the strep bacteria [5].
• Benzathine penicillin G: This medication is recommended for preventing recurrences and development of RHD [6].
• Amoxicillin: This is the recommended first-line drug for endocarditis prophylaxis in patients with specified cardiac conditions [7].

Additional Treatment Options

Other treatment options may include:

• Salicylates and corticosteroids: These are used as the mainstay of anti-inflammatory treatment for acute rheumatic fever (ARF) [8].
• Enalapril: This medication has been shown to reduce left ventricular diameter and volume in patients with mitral regurgitation (MR) [9].

Prevention is Key

The best treatment for RHD is prevention. Fever prevention through antibiotic treatments can help prevent the development of RHD [11].

Differential Diagnosis of Rheumatic Heart Disease

Rheumatic heart disease (RHD) is a serious complication of rheumatic fever, and its differential diagnosis can be challenging. The following conditions should be considered in the differential diagnosis of RHD:

• Endocarditis: This condition involves inflammation of the inner lining of the heart, which can lead to scarring and damage to the heart valves.
• Functional mitral regurgitation associated with viral infections: In some cases, functional mitral regurgitation (a condition where the mitral valve does not close properly) can be associated with viral infections, which may mimic the symptoms of RHD.
• Acute rheumatic fever (ARF): ARF is an autoimmune inflammatory process that develops as a sequela of streptococcal infection. It can manifest in various ways and remains a clinical syndrome for which no specific diagnostic test exists.

Key Factors to Consider

When considering the differential diagnosis of RHD, it's essential to take into account the following factors:

• Recent history of strep infection or rheumatic fever: A recent history of streptococcal infection or rheumatic fever is a crucial factor in diagnosing RHD.
• Symptoms and physical examination findings: The symptoms and physical examination findings can help differentiate RHD from other conditions. For example, RHD may present with heart failure, while endocarditis may present with signs of sepsis.

References

• [2] Acute rheumatic fever (ARF) is an autoimmune inflammatory process that develops as a sequela of streptococcal infection.
• [4] Rheumatic heart disease is the most serious complication of rheumatic fever.
• [6] The differential diagnosis may include specific autoimmune diseases, inflammatory diseases, cancers, and other conditions.

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