Last week, a mission of 60 medical and healthcare specialists from Team Heart Foundation, an international non-profit organisation based in Boston, Massachusetts, US, carried out 16 patients with advanced heart failure at King Faisal Hospital, Kigali.

Beatrice Uwera, a 28-year-old mother of one was among the lucky patients that underwent a successful heart surgery. With a seven months old baby, Uwera is thankful to the team because of saving both her life and that of her baby.

"When I was pregnant, I used to feel tired, which my doctors said wasn’t normal. However, they couldn’t tell me the exact cause. When sleeping, sometimes it was hard for me to breathe well, but just like any other pregnancy, I thought it was normal until my final antenatal visits, where the doctors said I might be having a heart problem,” she says.

Although the doctor didn’t specify the heart problem, Uwera was transferred to King Faisal Hospital and put on the list of people to be operated on after being diagnosed with advanced heart failure that turned out to be rheumatic heart disease.

What is rheumatic heart disease?

According to Dr Patricia Come, a cardiologist from Harvard Vanquard, US, rheumatic heart disease is a chronic heart condition in which permanent damage to heart valves is caused by rheumatic fever.

The heart valves are damaged by a disease process that generally begins with a strep throat caused by a preceding group A Streptococcus (strep) infection, and may eventually cause rheumatic fever.

"Rheumatic fever causes your body to attack its own tissues after it’s been infected with the bacteria that causes strep throat. This reaction causes widespread inflammation throughout your body, which is the basis for all of the symptoms of rheumatic fever,” she says.

Dr Come adds that this is the most common acquired heart disease, especially in children between the age of five and 15. It’s brought about by rheumatic fever; the case is more common in developing countries where there is poverty, poor housing conditions, overcrowding, poor nutrition and lack of access to healthcare.

"If not treated early, it’s a relatively serious illness that can cause stroke, permanent damage to your heart and even death,” she says.

Signs and symptoms

Dr Nathan Ruhamya, a senior consultant cardiologist at King Faisal Hospital, says the signs are brought about by a reaction to the bacteria which is responsible for causing strep throat (group A streptococcus).

He says although not all cases of strep throat result in rheumatic fever, this can be prevented with diagnosis and treatment of sore throat.

Ruhamya, however, points out that a child or any adult with rheumatic fever manifests signs such as a sore throat and swollen lymph node, rashes that are red, problems in swallowing food, high fever, tonsils, a sore throat and headaches.

"Sore throats appear in patients about 10 days or weeks later, which could lead to people developing acute rheumatic fever if not treated earlier,” he says.

According to Dr Come, rheumatic fever can also be characterised by low to high grade fever, shifting joint pains, skin rash, involuntary movements of head and changes in heart rhythm. This is said to be due to deranged immune system of the body. Heart valves are damaged by the antigen/antibody complexes and heart failure occurs as a result.

"Even coverings of the heart can be affected. Once heart valves are damaged, cure is only by surgery. Medicines are given regularly to prevent infection and control the heart failure,” she says.

Prevention & treatment

Dr Ruhamya says the risk factors include an untreated sore throat, recurrent sore throat and overcrowding.

He says the best treatment for rheumatic heart disease is prevention of rheumatic fever.

"Prevention lies in preventing transmission of droplet infections. While coughing or sneezing, one should keep the mouth covered. Primary prevention of acute rheumatic fever (the prevention of initial attack) is achieved by treatment of acute throat infections caused by group A streptococcus,” he says.

Dr Ruhamya says this can be achieved by up to 10 days of an oral antibiotic (usually penicillin) or a single intramuscular penicillin injection.

However, Rachna Pande, an internal medicine specialist, says people who have had a previous attack of rheumatic fever are at high risk for a recurrent attack, which worsens the damage of the heart.

She explains that prevention of recurrent attacks of acute rheumatic is known as secondary prevention. This involves regular administration of antibiotics, and has to be continued for long time.

Pande notes that surgery is often required to repair or replace heart valves in patients with severely damaged valves, which is very expensive.

"However, the most effective way to make sure that the patient doesn’t develop rheumatic fever is to treat their strep throat infection quickly and thoroughly. This means making sure they complete all prescribed doses of medication. In addition, schedule a follow-up visit to ensure that they are free from strep bacteria antibodies,” she says.

Again, Dr Ruhamya says avoiding overcrowding, dwelling on good nutrition as well as seeking medical attention as earlier as possible is essential to prevent rheumatic heart disease.