South Africa has the fourth highest fatalities due to rheumatic heart disease (RHD) in the world, approximately 1 600 cases per year. RHD affects mainly children and young adults in low income communities in developing countries. Poor living conditions, overcrowding, poor nutrition and lack of healthcare contribute to the severity and spreading of RHD.

What is RHD?

Rheumatic heart disease is a chronic heart condition caused by damage to the heart after contracting acute rheumatic fever (ARF). ARF is an immune illness caused by a reaction to a group A streptococcus bacterial infection. It affects many parts of the body, including the heart, joints, brain and skin. It usually leaves no permanent damage, except to the heart.

RHD can be in the form of an inflamed heart, damage to heart valves (e.g. stretching or scarring) or the interruption of blood flow to and from the heart. These symptoms can be made worse by recurring ARF episodes and can lead to heart failure and death. In fact, HRD is the sixth highest cause of heart disease fatalities in South Africa.

What causes RHD?

The exact cause is not known, but it can occur between one to five weeks after an ARF infection. A possible cause is that the immune systems of certain individuals become overactive when trying to control the streptococcus bacterium, which leads to inflamed and damaged heart tissue.

Symptoms

Symptoms usually appear two to four weeks after the streptococcal infection. It can include the following:

    • Fever
    • Joint pain or swelling
    • Abdominal pain
    • Vomiting
    • Skin rash (that do not itch) or small lumps under the skin
    • Involuntary jerky movements or shakiness of parts of the body
    • Muscle pain or a loss of muscle tone
    • Confusion
    • Speech difficulties
    • Coughing
    • Fatigue and weakness
    • Chest pain and heart palpitations.

Prevention and treatment

A streptococcal infection can be treated with antibiotics; therefore, through early diagnoses and treatment rheumatic fever and RHD can thus be prevented and controlled.

As this is a condition that tends to affect poorer communities, social, economic and environmental steps should be taken to minimise the spreading and developing into rheumatic fever and RHD. The availability of antibiotics to treat the bacterial infection before it develops into rheumatic fever is important.

People who have suffered from rheumatic fever in the past are more likely to contract it again and therefore need long-term antibiotic treatment to prevent RHD.

The most common resulting damage caused by rheumatic fever is heart valve damage. This can occur ten to 30 years after the initial infection. If the valve damage is advanced, a heart valve replacement may be necessary. This is a very expensive procedure and therefore state hospitals can only perform a limited amount of these operations. Many patients die while waiting for an operation.

If you think that someone has RHD, get them to a doctor as soon as possible. Good living conditions and accessibility of appropriate antibiotics has led to a decrease in rheumatic fever cases in developed countries.

 

Sources
http://www.health24.com
http://www.rhdaustralia.org.au
http://www.world-heart-federation.org/press/fact-sheets/rheumatic-heart-disease/