Rheumatic heart disease, also known as RHD, is a consequence of acute rheumatic fever or ARF. Although recurrent episodes acute rheumatic fever or multiple attacks usually cause Rheumatic heart disease, but at times, a single case of acute rheumatic fever might also lead to the life-threatening disease of rheumatic heart disease. Mostly, it is a result of cases, where the acute rheumatic fever is not recognised and treated on time. But the disease must be treated right at its root, when the root cause of bacteria called Group A streptococcus, attacks the throat and gradually leads to collapse of the heart as the valves fail to properly pump blood, when not treated at the roots.
Good-to-Know Facts For Preventing Rheumatic Heart Disease:
Rheumatic Fever which if avoided causes Rheumatic Heart Disease and can take a serious turn if neglected. Rheumatic Heart Disease occurs more in children and young adults and could take a life-threatening turn. Thus preventing Rheumatic Heart Disease at the beginning is the best possible thing. However, before focusing on the symptoms few facts must be noted which helps in the prevention and early detection of Rheumatic Heart Disease.
Risk Factors and Occurrence of Rheumatic Heart Disease:
Although this disease is mostly visible in children in between the age of 5 and 15, it can also occur in people of any age group. Every year about 233,000 people die from Rheumatic Heart Disease and majorly they are children and young adults, who are living in countries with low-income that is in an overcrowded and poverty stricken area that is remotely situated with limited access to medical care. Almost 1% of all school children in Asia, Africa, Latin America and Eastern Mediterranean region are showing signs of this disease and the indigenous populations of Australia, New Zealand, sub-Saharan Africa, the Pacific and the south-central Asia are the areas that are worst affected. More than 15.6 million people are suffering from this Rheumatic Heart Disease in the entire world at this present moment.
Identifying Rheumatic Heart Disease with its Symptoms:
When the rheumatic fever is not treated on time, it leads to rheumatic heart disease. To prevent the rheumatic fever from affecting the heart with rheumatic heart disease, its symptoms need to be identified for a 'subclinical' assessment. Once the heart and the connecting tissues are affected by the Group A streptococcus, the symptoms that can be witnessed are:
- Heart palpitation and chest pain
- A feeling of breathlessness upon exertion, orthopnoea or breathing problems when lying down
- Syncope or fainting and edema or swelling of the body
- Paroxysmal nocturnal dyspnea or need to wake up from sleep for sitting or walking, with the hope of comfort
- Damaged heart valves leading to stroke.
Prevention of Rheumatic Heart Disease:
As Rheumatic Heart Disease is a disease that is caused by bacteria, therefore, the practical and the most systematic way of preventing it should be with antibiotics, unless the bacteria is not resistant to the antibiotic. GAS or Group A Streptococcus have been sensitive to Penicillin. Prevention of Rheumatic Heart Disease can be done in two ways and they are primary and secondary procedures.
Benzathine benzyl penicillin injection is the most common and basics of prevention of Rheumatic Heart Disease. Apart from this, Phenoxymethyl penicillin or Pen VK is also applied along with Erythromycin ethylsucci in cases, where Benzathine benzyl penicillin is not applied. In extreme unusual cases, Anaphylaxis is also applied for preventing the rheumatic fever to affect the heart.
Although the cost of this preventive measure for Rheumatic Heart Disease using Primary Prophylaxis is often a question of much concern, it only costs US $46 for each penicillin injection, but if not provided, it might consequently lead to a rheumatic heart. Once the Rheumatic Heart Disease occurs, there is no way other than a surgery which costs US$15,000. When the surgery is being considered, it must also be mentioned that not all the countries are equipped with such surgical facilities and infrastructure.
However, the primary prevention is more difficult to achieve in reality than in theory. To eradicate Group A Streptococcus or prevent its impact the individual needs to –
- Create public awareness of the Strep Sore Throat
- Identify the sore throat as a GAS infection
- Use injectable penicillin to prevent from leading to RHD.
The World Health Organization along with the World Heart Federation has approved the secondary prophylaxis as an even more useful method for preventing Rheumatic Heart Disease. As penicillin prophylaxis has not been proven useful for preventing Rheumatic Heart Disease in all children with subclinical rheumatic valve lesions, it is not recommended for them. Penicillin prophylaxis is therefore used mostly for those children who have threat of "significant subclinical rheumatic heart disease".
Secondary Prophylaxis on the other hand is a more suitable option for preventing Rheumatic Heart Disease. In this prevention programme, penicillin injection is applied immediately after a first episode of acute rheumatic fever. After that, a monthly penicillin injection application follows up till the third decade of the patient's life. This register based control is more useful in preventing the disease in a widespread mode and also considered by most countries because of its cost-effectiveness and inexpensiveness.
The secondary prophylaxis is more useful since the primary prophylaxis is unable to prevent the recurrence of the repeated attacks. Rheumatic fever has a tendency to re-occur and to prevent that, the Benzathine penicillin or penicillin prophylaxis is applied. This is necessary to make sure that the repeated application of this injection prevents further occurrence of the disease which might damage the heart valve tissue when recurred time and again. However, this secondary prevention cannot prevent the initial damage and can only prevent further new attacks.
Importance of Hygiene and Health:
It has been seen that primary prophylaxis is not adequate for the prevention of Rheumatic Heart Disease and a dramatic improvement in the condition of the health can be achieved by providing hygiene infrastructure. As the prevalence of the rheumatic heart disease has been attributed to unhygienic living and overcrowding related to low socio-economic status, improvement of nutrition will lead to a better immune response and thus fight and resist the infection.
Necessary Condition for Prevention of Rheumatic Heart Disease in Children and Young Adults:
To prevent the children and young adults, who are likely to be affected by this disease, it is very important that early detection of the "subclinical" rheumatic valve is done. With such detections, it is always possible to prevent recurrent episodes by application of prophylactic penicillin as a preventive measure. Traditionally this detection of the possibility for rheumatic heart disease is done by listening to the murmurs by stethoscope and in suspected cases; it is followed by echocardiographic confirmation.
Consequences of Failure To Prevent Rheumatic Heart Disease:
- The failure of proper diagnosis of Rheumatic Heart Disease leads to irregular closing and opening of heart valves resulting in erratic blood flows across the heart. This causes heart to enlarge and ultimately to form blood clots. These clots when not properly pumped, blocks the blood vessels connecting brain and stroke takes place. Sometimes, secondary infection is also caused by damaged valves known as infective endocarditis.
- St. Vitus' dance or Sydenham chorea: Rheumatic fever, often along with leading to rheumatic heart disease, causes other disorders and the most common one is the neurological or nervous system disorder which is known as St. Vitus' dance. It is an involuntary, uncontrollable and jerky movement of the feet, hands and face.
- Chorea: Sometimes, this chorea associates inappropriate laughing and crying as the nervous system is affected by the disease.
- Erythema marginatum: In this disease, a little flat or at time, slightly raised painless rashes occur on the skin, especially on the ragged edges.
Although prevention is the first priority for this disease, yet if Rheumatic Heart Disease has already occurred, there are still ways available to treat it and stop from further worsening of the condition. Application of antibiotics is done to make sure that the bacteria does not spread further damaging the valves and in cases, where severe damage has been done to the heart valves, surgery is done to replace or repair the heart valves.