Rheumatic heart disease

Many young boys and girls previously healthy can develop chronic heart disease due to rheumatic fever. Suddenly a normal child starts getting breathless on exertion, develops swelling over feet and untreated gets worse progressively. People wonder what has gone wrong. Rheumatic heart disease is one of the leading preventable causes of heart disease among adolescents and young adults in developing countries. Rheumatic fever is caused by immunological reaction against throat infection by the bacteria called Beta-haemolytic streptococcus. The bacteria usually cause an infection manifested by fever, inflamed tonsils and difficulty in speaking or swallowing. Rheumatic fever can occur about 4 weeks following the sore throat. It is said to be due to immunological reaction of the body to the infecting microbes. Rheumatic fever usually affects children from 4 to 14 years but adults are not exempt. It is usually more common in poor children living in slums. Reason being overcrowding causes streptococcal throat infections and cross infections more frequently. School going children also are at risk of exposure to infection as after rains or in cold weather many children develop throat infections, including that by beta haemolytic streptococci, i.e. implicated in rheumatic fever. Among adults, professionals like teachers, doctors and nurses are at risk of infection because of being exposed to the germ many times. Mild infection usually subsides unnoticed without treatment. It is only when the child has fever or severe or persistent sore throat that families usually bother about treatment. Untreated streptococcal infection can very well damage the heart. Along with fever and joint pain Heart is affected during acute rheumatic fever, along with high fever, multiple joint pains, skin rashes and at times chorea (abnormal movement of head). It is said that, “rheumatic fever licks the joints but bites the heart”. All layers of the heart may be inflamed causing an abnormal sound on examination. The person may develop acute cardiac failure manifesting as sudden breathlessness, rhythm disturbances and swelling over feet. Some years after acute rheumatic fever, there may be permanent damage to heart valves producing chronic heart failure. There is breathlessness even on rest and lying down, swelling on feet and then whole body. A person becomes asthenic and looses the capacity to work. Fluid may develop in the coverings of the heart as they get inflamed, aggravating the symptoms. As the cardiac failure progresses, the person may develop liver and kidney failure also. There is risk of infection of the inner layer of the valves which can be a grave condition. Portion of inflammatory deposits over the inner layer may break and pass on with blood stream to the brain. Here it may occlude blood supply to part of brain thus causing a stroke in a youngster. Thus one affected by rheumatic heart disease is bound to remain chronically sick with cardiac disease or the related complications. Treatment is by antibiotics preferably penicillin. In an individual who has already developed the disease, penicillin is given regularly to prevent infection of the heart valves. Considering the grave effects of rheumatic fever on the heart it should be considered a potentially serious disease. Greater awareness needs to be generated among people regarding this disease. Ideally a person needs to keep a healthy body by means of healthy and disciplined habits, thus minimising chances of damages caused by any microbe. Children should also be taught the healthy habit of keeping mouth covered while coughing to prevent spread of infections. But if infected, one should never take a “sore throat” lightly. Timely treatment taken can prevent rheumatic fever and rheumatic heart disease. It will not only prevent sickness in an individual but reduce the burden of a preventable disease in the society. E-mail: rachna212002@yahoo.co.uk