Rheumatic Valve Disease

A past case of strep throat or rheumatic fever helps to diagnose rheumatic heart disease. Rheumatic fever symptoms can differ from person to person. Symptoms usually begin 1 to 6 weeks after having strep throat. Sometimes, the infection might have been too mild to notice. Or it may have cleared up by the time the person seeks medical help.

These are the most common symptoms of rheumatic fever: 

• Fever
• Painful joints, especially knees, ankles, elbows and wrists
• Heart murmur
• Painless lumps under the skin (nodules)
• Red, raised, lattice-like rash, often on the chest, back and belly
• Uncontrolled movements of arms, legs or facial muscles
• Weakness

After rheumatic fever, symptoms of rheumatic heart disease depend on the degree of valve damage and may include: 

• Shortness of breath (very often with activity or when lying down)
• Chest pain
• Swelling

Rheumatic fever is primarily caused by an untreated or inadequately treated infection with group A Streptococcus bacterium, commonly known as strep throat or scarlet fever. The body’s immune response to the strep infection can mistakenly attack healthy tissues, particularly in the heart, joints, skin and brain. This autoimmune reaction can result in inflammation and tissue damage.  

Poor sanitation, crowded living conditions and limited access to medical care can increase the risk of developing rheumatic fever. Early diagnosis and treatment of strep throat with antibiotics are crucial to preventing this disease. 

Several risk factors increase the likelihood of developing rheumatic fever: 

• Age: Rheumatic fever most commonly affects children and adolescents between the ages of 5 and 15.
• Strep throat infection: A recent infection with group A Streptococcus bacterium, particularly if untreated or inadequately treated, significantly raises the risk.
• Genetics: A family history of rheumatic fever can predispose individuals to the condition due to genetic susceptibility.
• Environmental factors: Living in crowded or unsanitary conditions, which facilitate the spread of strep bacteria, increases the risk.
• Socioeconomic status: Limited access to medical care, leading to untreated or improperly treated strep infections, is a notable risk factor. 

Individuals with rheumatic heart disease typically have or have recently had a strep infection. During a routine physical exam, your healthcare provider may discover a heart murmur or other abnormal heart sounds such as a “rub.” The murmur results from turbulent blood flow through the damaged valve, while a rub occurs when the inflamed heart muscle and the tissues around it rub against each other.

In addition to your health history and physical exam, your doctor may request some of the following tests: 

• Electrocardiogram (ECG): This test records the strength and timing of the heart's electrical activity. It can reveal abnormal rhythms (arrhythmias or dysrhythmias) and sometimes detect heart muscle damage.
• Chest X-ray: This imaging test checks the lungs and can provide clues that the heart is enlarged.
• Blood tests: These tests may be used to detect infection and inflammation.
• Echocardiogram (echo): This test uses sound waves to check the heart's chambers and valves.  
• Transesophageal echo or TEE: This also uses soundwaves to visualize the heart but unlike a standard echocardiogram, where the ultrasound probe is placed on the chest, TEE involves inserting a specialized probe down the patient's esophagus, just as is done during an endoscopy. Because the esophagus is located close to the heart, this method provides clearer and more precise images, especially of the heart valves and chambers.
• Cardiac CT or MRI: These detailed imaging tests take precise pictures of the heart and can be used in addition to echo to examine the heart valves and muscle more closely. 

Preventing rheumatic heart disease primarily involves the prompt and effective treatment of strep throat infections with appropriate antibiotics. Ensuring early diagnosis and completing the full course of antibiotics can prevent the initial onset of rheumatic fever. 

Regular follow-up and long-term preventive antibiotics for those who have had rheumatic fever can prevent recurrent infections and further heart damage. Access to quality healthcare and education about the importance of treating strep throat is crucial in reducing the incidence of rheumatic heart disease.

Living with rheumatic heart disease requires regular medical check-ups and adhering to prescribed treatments, including long-term antibiotics to prevent further infections. Patients need to manage symptoms and avoid activities that strain the heart. 

A healthy lifestyle, including a balanced diet and regular exercise, is important, along with avoiding smoking and excessive alcohol consumption. Staying informed about the condition and communicating with healthcare providers can help manage the disease effectively and maintain a good quality of life.