Rheumatic Heart Disease

Rheumatic Heart Disease is the complication that takes place as a result of rheumatic fever whereby one or more heart valves are damaged, but it can also injury the heart muscles and the lining of the heart. This kind of cardiovascular disease is caused when acute rheumatic fever maintains reoccurring resulting in the inflammation of the heart muscle. The heart valves usually become and can continue to be stretched and scarred causing the interruption of normal blood waft in the damaged valves. Blood can be blocked from flowing because of the scarred valves that do now not open properly, or it can flow backward through the stretched valves that are unable to close properly. Heart surgery cannot be cured but can be managed through heart surgery in which life is prolonged.

The acute rheumatic fever is as a result of a preceding group A streptococcal infection. Antibiotics are used to treat strep throat so as to prevent rheumatic fever from occurring, and conventional antibiotics administered through injections can prevent patients that have a rheumatic fever from getting further strep infections that would ultimately cause the progression of valve damage. Some of the risk factors for RHD include limited access to medical care, poverty, and overcrowding (Mackay 125). If episodes of recurrent acute rheumatic fever are stopped in time, it can prevent the occurrence of rheumatic heart disease. It is not common for RHD to cause any symptoms but when it does its symptoms may appear depending on the extent of the heart damage and its location. The symptoms may include chest pains, heart palpitations, excessive fatigue, thumping sensation in the chest, swollen ankles, wrists, & stomach, stroke, fever as a result of infected heart valves, and shortness of breath. An individual with RHD can also have paroxysmal nocturnal dyspnoea whereby they usually wake up from sleeping having the need to sit up or stand up and they can also have breathing problems when they are lying down this condition is known as orthopnoea. One of the main symptoms that most people with RHD have includes a heart murmur that can only be heard through a stethoscope. 

Pathophysiology of Rheumatic Heart Disease

Acute rheumatic fever is affecting children and adolescents after they have had an episode known as upper tract infection that is usually as a result of the bacteria known as A beta-hemolytic Streptococcus. This bacterium attaches itself to the epithelial cells that are in the respiratory tract; they then produce enzymes that usually cause a distraction to the tissues that are surrounding. The inflammatory process only shows symptoms after two to four days of the incubation period, and they might range from a sore throat, high fever, body weakness, headache, and an increase in the count of white blood cells. The tissue injury that occurs during the rheumatic fever is accounted for by the molecular mimicry. The defenses of a genetically vulnerable host such as humoral and cellular are also involved in the rheumatic fever. The upper respiratory tract infection that is caused by this bacterium is often contagious and is easily spread through oral and respiratory secretions. An individual who has an active immune system and gets access to treatment more than often recover from the infections without any complications included. About 3% of patients who have been treated for rheumatic fever usually develop it again after several weeks and this result in rheumatic heart disease. Some of the research done point out that particular protein that is produced by the group A Streptococci their structures are similar to those that are found in the heart (Nussinovitch 735). When bacteria is detected by the immune system, it produces specific substances that are called antibodies which attack and stop further spreading inside the body. The manifestation of RHD occurs when antibodies are attacking the body attack also the tissues in the heart. The many RHD symptoms that occur include carditis, endocarditis, pericarditis, and myocarditis. Myocarditis is as a result of the heart muscles being affected by inflammation. Pericarditis takes root when the sac that surrounds the heart becomes inflamed. As for the endocarditis, it is as a result of the inner layer of the heart being involved in the inflammatory process.

Evolution of Rheumatic Heart Disease

The onset of the disease is most of the time difficult or impossible to know if one has acquired as it does not show symptoms. Research has found that 75% of the rheumatic attacks usually resolve after six weeks, 90% resolve after twelve weeks, while 5% only resolve in six months (Labarthe 665). The rheumatic fever symptoms usually stop occurring more than two months after treatment was interrupted through the use of salicylates or cortisone. The only time the symptoms can begin again is when a patient gets a new streptococcal infection. The severity of the carditis will determine what the prognosis will be. Severe myocarditis can cause death during an attack or heart failure because of valve damage. Deaths in adults are as a result of bacterial endocarditis, heart failure, systemic and pulmonary embolism. For young people who have severe RHD at the time when they get diagnosed the disease rapidly progresses resulting in a poor prognosis. For a patient who had moderate RHD at the time of diagnosis, their prognosis becomes mixed as there are high chances that one-third would progress to severe RHD another one-third would have regressed to mild RHD. While those that have mild RHD, at the time of diagnosis had a high chance of having a favorable prognosis. 

Current diagnostic procedures are done to evaluate Rheumatic Heart Disease

The first step towards getting a diagnosis of rheumatic heart disease is to establish if the child had a strep infection. The doctor will then order for both the throat culture and blood test to check if there is the presence of antibodies. The medical history of a patient is also used to help in the diagnosis as it may include evidence of strep infection or past acute rheumatic fever. Diagnosis can as well be made through blood cultures so as to rule out infections such as endocarditis, disseminated gonococcal, and bacteremia. Imaging studies that are also used for diagnosis include chest radiography, electrocardiogram, and echocardiography (Traut 857). Chest radiography aids in revealing CHF and cardiomegaly for the patients that have carditis. The chest radiography will check for excess fluid in the heart and lungs as well as test the size of the heart. Echocardiography is usually suitable for patients that do not have any clinical manifestations of carditis as it will help in demonstrating valvular regurgitant lesions in the patients that have ARF. The echocardiography test is non-invasive, and it uses sound waves to measure the size & shape of the heart as well as to create a moving image of the heart. An electrocardiogram is conducted as a way to record the electric activity of the heart which includes checking if the heart rate and rhythm are normal.

Current therapeutic modalities for Rheumatic Heart Disease

Treatment for rheumatic heart disease can include the use of antibiotics for infection, blood thinning medicine for prevention of a stroke happening. Penicillin and amoxicillin for children are administered, and in cases where one is allergic to penicillin, they will be given erythromycin or the second generation cephalosporin (Traut 883). When conditions have become worse an individual will go through heart valve surgery so as to repair the damaged heart valves. The heart surgery can be the inserting of a pacemaker that will regulate the heart rate and rhythm. Preventative and prophylactic therapy is done so as to prevent any further damage to the heart valves. Cardiac Catheterization can be done whereby a cardiologist will insert catheters which are small plastic tubes into the veins and arteries so as to treat the heart condition. For valves that are stuck balloons are inserted through the veins so as to open them up. 

The medical treatment of rheumatic heart disease also includes reducing the chances of complications occurring. For to ensure that there is no risk of complications they should make sure that they go for regular check-ups with a cardiologist, get up to date vaccinations which include influenza & pneumococcal, conventional preventative antibiotics for Group A Streptococcus throat infection and early presentation and diagnosis and the appropriate antibiotic treatment for sore throats administered. Another way to reduce complications is by getting good prenatal care because pregnancies can aggravate rheumatic heart disease.

Conclusion 

Rheumatic heart disease is as a result of acute rheumatic fever going untreated. If ARF is promptly diagnosed and the preventative antibiotics are taken, it can prevent it from reoccurring and prevent from progressing to RHD. Depending on when the last attack of ARF was a person will have to be on prophylactic antibiotics until they reach 20 years to 40 years and this is done whether they had RHD or they did not have it. Rheumatic heart disease and acute rheumatic fever are preventable and manageable but cannot be cured. The use of antibiotic therapy like penicillin to treat Group A streptococcus throat infection will significantly reduce the risk of the ARF complications and the chances rheumatic heart disease. In the case of the occurrence of RHD and ARF to reduce the diseases progressing to more severe ones, long-term antibiotics are usually used. It is important to note and remember that rheumatic heart disease is as a result of acute rheumatic fever episodes being recurrent. The incidences of rheumatic heart disease are maybe decreasing especially in countries that are developing, but it is still a problem for many heart surgeons out there.

Work Cited

Labarthe, Darwin. "Rheumatic Heart Disease." Epidemiology and Prevention of Cardiovascular Diseases (2015): 660-681.

Mackay, Judith. "New Insights for the Healthcare Professional." Rheumatic Heart Disease (2012): 96-138.

Nussinovitch, Udi. "Pathophysiology, Clinical ." The Heart in Rheumatic, Autoimmune and Inflammatory Diseases (2017): 699-766.

Traut, Eugene F. "Rheumatic Diseases, Diagnosis, and Treatment." Cardiovascular System (2013): 830-900.

Vijayalakshmi, I B. "Chronic Rheumatic Heart Disease." Acute Rheumatic Fever (2013): 350-464.