Rheumatic Heart Disease (RHD) Treatment in Delhi, India

Rheumatic heart disease is a condition where the heart valves become damaged due to an autoimmune response triggered by untreated streptococcal infections, leading to inflammation and scarring of the valves. Over time, this can result in problems with blood flow through the heart and may lead to symptoms such as shortness of breath, fatigue, chest pain, and swelling.

RHD is primarily caused by an abnormal immune response to untreated streptococcal infections, particularly Group A Streptococcus bacteria. When the body's immune system mistakenly attacks its own tissues, including those of the heart valves, it leads to inflammation and damage. Genetic factors and environmental conditions also contribute to an individual's susceptibility to RHD.

Here are some of the main risk factors associated with RHD.

• Untreated Strep Throat: Failure to treat streptococcal throat infections promptly with antibiotics increases the risk of developing rheumatic fever and subsequently RHD.
• Genetic Predisposition: Certain genetic factors may make some individuals more susceptible to developing rheumatic fever and RHD.
• Environmental Factors: Overcrowded living conditions, poor access to healthcare, and socioeconomic factors can increase the risk of streptococcal infections, which in turn raises the risk of RHD.
• Age and Gender: RHD is more common in children and young adults, particularly between the ages of 5 and 15. Females are also more likely to develop RHD than males.
• Geographical Location: RHD is more prevalent in low-income and middle-income countries, especially in regions where streptococcal infections are common and access to healthcare is limited.

These risk factors highlight the importance of prompt treatment of streptococcal infections, particularly in populations at higher risk, and efforts to improve access to healthcare and address socioeconomic disparities to reduce the burden of RHD

Rheumatic heart disease (RHD) can cause a variety of symptoms, depending on the severity of the condition and which heart valves are affected. Common symptoms of rheumatic heart disease may include:

• Shortness of Breath: Difficulty breathing, especially during physical exertion or when lying down flat (orthopnea).
• Fatigue: Feeling unusually tired or lacking in energy, even with minimal activity.
• Chest Pain: Discomfort or pain in the chest, which may feel like pressure, tightness, or squeezing. This pain may worsen during physical activity or when lying down.
• Palpitations: Sensation of rapid, fluttering, or pounding heartbeats.
• Swelling: Swelling of the legs, ankles, feet, or abdomen (edema) due to fluid retention, which can occur as a result of heart failure.
• Fainting or Dizziness: Feeling lightheaded, dizzy, or fainting (syncope) may occur due to decreased blood flow to the brain.
• Cough: Persistent cough, sometimes with frothy or blood-tinged sputum, particularly if heart failure is present.
• Fever: Some individuals with RHD may experience recurrent episodes of fever, especially if there are active inflammatory processes ongoing.
• Joint Pain: Rheumatic fever, which precedes RHD, can cause inflammation and pain in joints, known as rheumatic arthritis.
• Weight Loss: Unexplained weight loss may occur in some individuals, particularly in advanced stages of heart failure.

It's important to note that the symptoms of rheumatic heart disease can vary widely among individuals and may also mimic those of other heart conditions. Additionally, some individuals with RHD may not experience noticeable symptoms until the condition has progressed significantly.

Diagnosing rheumatic heart disease (RHD) often involves a combination of approaches since symptoms may not be apparent and the disease can mimic other conditions. Here's what a Rheumatic Heart Disease diagnosis might include:

• Medical History and Physical Examination: The doctor will ask about symptoms, medical history, and risk factors, and perform a physical exam to listen for abnormal heart sounds (heart murmurs) and check for signs of heart failure or other complications.
• Blood Tests: Blood tests may be done to check for markers of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), as well as to detect evidence of a recent streptococcal infection.
• Echocardiogram: This non-invasive imaging test uses sound waves to create detailed images of the heart's structure and function. It can help visualise any abnormalities in the heart valves, such as thickening, scarring, or regurgitation (leakage).
• Electrocardiogram (ECG or EKG): This test measures the electrical activity of the heart and can detect abnormal rhythms (arrhythmias) and signs of heart enlargement or strain.
• Chest X-ray: A chest X-ray may be performed to assess the size and shape of the heart and detect signs of heart failure, such as fluid buildup in the lungs.
• Cardiac MRI or CT Scan: These imaging tests provide more detailed views of the heart and may be used to evaluate the extent of valve damage and assess overall heart function.

There's no cure for RHD, but treatment can manage symptoms, prevent further damage, and improve quality of life. Here are the main approaches:

Medications

• Antibiotics: Antibiotics are used to treat streptococcal infections promptly and prevent recurrent episodes of rheumatic fever.
• Anti-inflammatory drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids may be prescribed to reduce inflammation during acute episodes of rheumatic fever.
• Medications for heart failure: Drugs such as diuretics, ACE inhibitors, beta-blockers, and digoxin may be prescribed to manage symptoms and improve heart function in individuals with heart failure due to RHD.
• Anticoagulants: These medications help prevent blood clots from forming in the heart chambers and reduce the risk of stroke in individuals with atrial fibrillation or other high-risk conditions.

Surgical Interventions

• Valve repair or replacement: In cases of severe valve damage, surgical repair or replacement of the affected heart valves may be necessary to restore normal blood flow through the heart.
• Balloon valvuloplasty: This minimally invasive procedure may be used to widen narrowed heart valves using a balloon catheter.

Lifestyle Changes

Adopting a heart-healthy lifestyle, including regular exercise, maintaining a healthy weight, following a balanced diet low in sodium and saturated fats, quitting smoking, and managing stress, can help improve overall heart health and reduce the risk of complications.

Regular Follow-up Care

Individuals with RHD require regular monitoring by a healthcare provider to assess heart function, manage symptoms, adjust medications as needed, and detect any complications early.

Treatment for rheumatic heart disease aims to alleviate symptoms, prevent complications, and improve overall quality of life. The specific treatment approach will vary depending on the severity of the condition, the presence of complications, and individual factors such as age and overall health.

Rheumatic heart disease (RHD) can lead to various complications if left untreated or if the valve damage is severe. Here's a breakdown of some potential consequences:

• Heart failure: This occurs when the heart weakens and can't pump blood effectively. Symptoms include shortness of breath, fatigue, and swelling in the legs and ankles.
• Arrhythmias: These are irregular heartbeats that can cause palpitations, dizziness, and even fainting. In severe cases, they can lead to heart failure or sudden cardiac death.
• Pulmonary hypertension: High blood pressure in the lungs caused by a failing heart right ventricle. This can worsen shortness of breath and fatigue.
• Stroke: Blood clots forming on damaged heart valves can travel to the brain and block blood flow, causing a stroke.
• Endocarditis: This is an infection of the inner lining of the heart, including the valves. It's a serious complication for people with RHD as damaged valves are more susceptible to infection.
• Pregnancy complications: RHD can increase the risk of complications during pregnancy for both mother and baby.

Rheumatic heart disease is largely preventable. Here are some key strategies to reduce the risk of developing this condition:

• Prompt treatment of strep throat: If symptoms like sore throat, fever, and swollen glands arise, consulting a doctor for a strep test and appropriate antibiotics is crucial to treat the infection.
• Maintaining good hygiene: Frequent handwashing and avoiding close contact with those who are sick can significantly reduce the spread of strep throat bacteria.
• Early diagnosis of rheumatic fever: If rheumatic fever is suspected, prompt diagnosis and treatment can minimise damage to the heart valves.
• Antibiotic prophylaxis: Individuals with a history of rheumatic fever can benefit from long-term, low-dose antibiotics to help prevent recurrent infections and further heart damage.

Following the above preventive measures can significantly decrease the risk of developing rheumatic heart disease.

How common is rheumatic heart disease?

Rheumatic heart disease is less common in developed countries but remains prevalent in low- and middle-income regions, particularly where access to healthcare is limited.

Who is at risk for rheumatic heart disease?

Individuals with a history of untreated streptococcal infections, particularly children and young adults living in overcrowded conditions with limited access to healthcare, are at higher risk.

How does rheumatic heart disease affect pregnant people?

RHD can increase the risk of complications during pregnancy, such as heart failure and arrhythmias, requiring close monitoring by healthcare providers specialised in high-risk pregnancies.

How does Rheumatic Fever damage the heart?

Rheumatic fever triggers an abnormal immune response, causing inflammation in the heart, particularly the heart valves, leading to scarring and damage, which can result in RHD.

Can ECG detect rheumatic heart disease?

An ECG can help detect abnormal heart rhythms and signs of heart enlargement but may not directly diagnose RHD. Imaging tests like echocardiography are more effective for RHD diagnosis.

What is acute rheumatic fever (ARF)?

Acute rheumatic fever is an inflammatory condition that develops in response to untreated streptococcal infections, primarily affecting the heart, joints, skin, and brain.

Can RHD affect children?

Yes, RHD can affect children, particularly in regions with high rates of streptococcal infections and limited access to healthcare.

What lifestyle changes can help manage RHD?

Lifestyle changes include regular exercise, maintaining a heart-healthy diet, quitting smoking, managing stress, and adhering to prescribed medications.

Can RHD affect children's growth and development?

Severe cases of RHD may impact children's growth and development due to reduced physical activity tolerance and potential complications affecting overall health.

Are there any alternative treatments for Rheumatic Heart Disease?

There are no alternative treatments for RHD; however, complementary therapies may be used to support conventional medical management and improve overall well-being.

Can Rheumatic Heart Disease lead to heart failure?

Yes, severe cases of RHD can lead to heart failure, where the heart cannot pump blood effectively, resulting in symptoms like shortness of breath and fatigue.

How does RHD affect life expectancy?

The impact on life expectancy varies depending on the severity of RHD, adherence to treatment, and access to healthcare, but with proper management, many individuals can live fulfilling lives.

Can Rheumatic Heart Disease recur after treatment?

Yes, RHD can recur, particularly if there are ongoing streptococcal infections or if treatment and preventive measures are not followed consistently. Regular medical follow-up is essential.

What is the outlook/prognosis for Rheumatic Heart Disease?

The outlook for individuals with rheumatic heart disease (RHD) depends on various factors, including the severity of valve damage, presence of complications, access to healthcare, and adherence to treatment and preventive measures. While RHD can lead to serious complications and affect quality of life, with proper management, many individuals can lead fulfilling lives and have a good prognosis. Also, it's important to note that RHD is a chronic condition that requires ongoing medical care and monitoring.

Reviewed By Dr. Munesh Tomar - Director - Cardiac Sciences, Cardiology, Paediatric (Ped), Cardiac Surgery on 19 Sept 2024.