Rheumatic Fever and Rheumatic Heart Disease

What Is Rheumatic Fever?

Rheumatic fever is a serious inflammatory disease that arises as a complication of partially treated strep throat or scarlet fever. These infections are caused by group A streptococcus bacteria.

Children from ages five to ten are the most commonly affected with rheumatic fever, but it can develop in infants and adults also. This type of fever can cause permanent damage to the heart valves and also lead to heart failure. Prompt treatment reduces inflammation, prevents complications, reduces the severity of symptoms, and prevents recurrence.

What Are the Causes of Rheumatic Fever?

Not all cases of strep throat (infection in tonsils and throat) lead to rheumatic fever. When a strep throat infection or scarlet fever has not been completely treated, the bacteria stay on. They act by confusing the body's immune system to target certain tissues of the body and treat them as foreign agents. This process, in turn, causes inflammation of the heart, skin, joints, and CNS (central nervous system).

Risk Factors:

1. History: Recent strep infection (caused by group A streptococcus bacteria).

2. Age: Children from five to ten years of age.

3. Environmental Factors: Overcrowded areas with poor sanitation.

What Are the Symptoms of Rheumatic Fever?

The symptoms of rheumatic fever vary. The patient can have one or more symptoms, which can change over the course of the disease. Symptoms of rheumatic fever generally start after two to four weeks of strep throat infection. The symptoms that are caused due to inflammation of the heart, skin, joints, and central nervous system are:

• Fever.

• Joint swelling and pain.

• Fleeting joint pain.

• Warmth and redness of joint.

• Swallowing difficulties.

• Sydenham chorea (jerky and uncontrolled movements in the face, hands, and feet).

• Skin rashes.

• Skin nodules.

• Tonsil enlargement.

• Chest pain.

• Headache.

• Nausea.

• Vomiting.

When to Consult a Doctor?

See a doctor if:

- You had a recent throat infection and developed a fever soon after.

- You have had rheumatic fever in the past.

- And you have it again.

When Should One Consult a Doctor?

See a doctor if:

• One had a recent throat infection and developed a fever soon after.

• A person has had rheumatic fever in the past.

• One experiences the condition again.

How Is Rheumatic Fever Diagnosed?

Diagnosis of rheumatic fever is based on medical history, physical examinations, and a few lab tests, as there is no specific test for it. It includes:

1. History of recent strep throat infection.

2. Fever with skin rashes or nodules, that appear painless, flat rash with a wavy edge.

3. Examination of joints to look for swelling.

4. Blood test to detect strep bacteria.

5. C-reactive protein and erythrocyte sedimentation rate to check for inflammation.

6. Heart monitoring with ECG (electrocardiogram) and echocardiogram.

7. Chest X-rays to see the heart enlargement and check the lungs.

How Is Rheumatic Fever Treated?

Treatment aims to destroy the streptococcal bacteria, relieve symptoms including inflammation, and prevent a recurrence. The treatment options include:

1. Antibiotics - The doctor will prescribe antibiotics for a long time to prevent the disease from coming back. The doctor might prescribe Penicillin or some other antibiotic. Antibiotics are given for five years or until 21 years of age, whichever is longer, to prevent recurrences. In the case of heart inflammation, antibiotics are given for ten years.

2. Anti-inflammatory Medicines - To reduce pain and inflammation, medicines such as Aspirin or Naproxen are prescribed. In the case of severe inflammation, corticosteroids are given.

3. Anticonvulsant Medicines - For Sydenham chorea, antiseizure medications like Valproic acid or Carbamazepine are prescribed.

4. Bed Rest - Best rest and restricted activities until pain and inflammation have subsided.

What Are the Complications of Rheumatic Fever?

The possible complications of rheumatic fever include:

1. Carditis - Inflammation of the heart.

2. Aortic Valve Stenosis - Narrowing of the heart's aortic valve.

3. Rheumatic Heart Disease - Permanently damaged heart valves.

4. Aortic Regurgitation - Blood flows in the wrong direction in the heart due to a leak in the aortic valve.

5. Atrial Fibrillation - Irregular heartbeat in the upper two heart chambers.

6. Heart Failure - The heart is unable to pump blood properly.

Failure to treat this condition can also result in stroke, permanent heart damage, and death.

What Is Rheumatic Heart Disease?

Rheumatic heart disease, otherwise called RHD, is a severe complication of rheumatic fever. RHD is long-term damage caused to the valves and tissues of the heart due to rheumatic fever. In severe cases, there is scarring and irreversible damage to the heart. If left untreated, it can lead to heart failure, where the heart is unable to pump blood to the rest of the body properly. This causes problems with blood flow through the heart valves, which requires surgical correction. The most worrying factor is that it can go undetected for years. If symptoms do appear, they can vary as feet swelling, chest pain, weakness, and tiredness.

Improperly treated rheumatic fever can result in gradual inflammation and deposition of calcium crystals inside and around the heart valves. Acute rheumatic fever can result in inflammation of one or more parts of the heart:

• Pericarditis - Surface of the heart.

• Endocarditis - Within the heart.

• Myocarditis - The heart muscle itself.

If the patient develops endocarditis, the inflammatory response results in permanent damage to one or more of the heart valves. This damage usually worsens with time.

Almost 50 % of people who suffer from acute rheumatic fever develop rheumatic heart disease. And most cases of RHD are diagnosed a decade or two after the episode of rheumatic fever.

Depending on the severity of the condition, people with RHD show the following signs and symptoms:

• Fever.

• Swollen and tender joints.

• Skin rashes (may appear as red or pink macules (flat spots) or small lumps or papules that spread outwards in a circular shape in RHD.

• Shortness of breath.

• Chest pain or discomfort.

• Weakness.

• Swollen feet and ankle.

Rheumatic heart disease can lead to mitral valve stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, tricuspid regurgitation, atrial fibrillation, and heart failure. Preventing and treating rheumatic fever is the ideal way of dealing with rheumatic heart disease.

How to Prevent Rheumatic Fever and Rheumatic Heart Disease?

Getting proper treatment for strep throat and scarlet fever is the best way to prevent rheumatic fever. Make sure your child takes all prescribed medicines properly. Things you can teach them to prevent all types of infections are:

1. Wash their hands frequently with proper hand washing methods and steps.

2. Not to come in contact with people who are sick.

3. Not to share personal items with others.

Conclusion:

Treating rheumatic fever at the right time and at the earliest will help prevent rheumatic heart disease. Consulting a rheumatologist or a cardiologist at the earliest will help prevent complications. A person living with rheumatic heart disease needs to have regular follow-ups with the doctor to monitor the heart’s condition. A doctor may suggest or ask a person to restrict certain activities depending on the extent of the heart damage. Since there are not many diagnostic tests available to find out rheumatic fever, it is not advisable to dismiss even the slightest symptom.