Rheumatic Heart Disease In Advanced Stages: What To Expect

Rheumatic heart disease (RHD) in its advanced stage is primarily characterized by severe damage to the heart valves, a condition often referred to as rheumatic valvular heart disease. As the disease progresses to this later stage, the heart valves undergo significant pathological changes, leading to a variety of symptoms that can severely impact a patient's quality of life.

Understanding Valve Damage In Advanced RHD

One of the most common manifestations of rheumatic heart disease is mitral valve stenosis. Normally, the mitral valve opening measures about 4-6 square centimeters. When the valve area narrows to 1.5-2 square centimeters, patients may experience mild or no symptoms at all. However, when the opening decreases further to below 1.5 square centimeters—classified as moderate to severe stenosis—symptoms become more pronounced and potentially debilitating.

Common Symptoms Of Severe Mitral Stenosis

One of the hallmark symptoms is shortness of breath, especially during physical exertion, after exercise, or during infections. This dyspnea tends to worsen over time and may progress to paroxysmal nocturnal dyspnea—sudden episodes of severe shortness of breath that awaken the patient from sleep. In advanced cases, patients may develop orthopnea, a condition where breathing becomes difficult unless sitting upright.

Complications Beyond The Heart

Advanced rheumatic heart disease doesn't just affect the structure and function of the heart valves; it can also lead to complications involving the lungs. As blood flow through the heart becomes restricted, pressure builds up in the pulmonary arteries and veins, resulting in pulmonary hypertension. This can cause additional symptoms such as persistent coughing, hemoptysis (coughing up blood), and fatigue.

Systemic Effects Of End-Stage RHD

As the heart's ability to pump blood efficiently declines, fluid retention becomes a common issue. Patients may notice swelling in the lower extremities, known as peripheral edema. This fluid buildup is a sign that the heart is struggling to maintain normal circulation, and it often indicates a worsening prognosis.

Managing Symptoms And Improving Quality Of Life

While the symptoms of advanced rheumatic heart disease can be severe, early diagnosis and appropriate medical management can significantly improve a patient's well-being. Treatment options may include medications to manage heart failure, anticoagulants to prevent blood clots, and in some cases, surgical interventions such as valve repair or replacement. Lifestyle adjustments and regular monitoring by a healthcare professional are also essential in managing this condition effectively.