Rheumatic Heart Disease: How Serious Can It Be?

Rheumatic heart disease (RHD) is a condition that can have varying levels of severity, largely depending on the extent of damage to the heart valves caused by rheumatic fever. Among the different valve complications associated with RHD, mitral stenosis—narrowing of the mitral valve—is the most common and can serve as a useful example to understand the progression of the disease.

Understanding Mitral Valve Stenosis

In the early stages, when the mitral valve area remains above 2 square centimeters, patients often experience no noticeable symptoms. However, as the valve begins to narrow further—falling between 1.5 and 2 square centimeters—individuals may start to notice symptoms such as shortness of breath, especially during physical exertion, persistent coughing, and even coughing up blood.

Progression to Severe Symptoms

As the condition worsens and the valve opening shrinks to between 1 and 1.5 square centimeters, symptoms become more pronounced. Patients may suffer from significant breathing difficulties, particularly during periods of rest or sleep. This can lead to nighttime breathlessness, a condition known as paroxysmal nocturnal dyspnea, and may require individuals to sit upright to breathe comfortably—a symptom referred to as orthopnea.

Complications Associated With Advanced RHD

If the mitral valve area drops below 1 square centimeter, the disease is considered severe. At this stage, complications can arise, including chronic heart failure, pulmonary hypertension (high blood pressure in the lung arteries), and atrial fibrillation—an irregular and often rapid heart rate. Additionally, patients face an increased risk of systemic or pulmonary embolism, where blood clots travel to other parts of the body or to the lungs, potentially causing life-threatening situations.

Conclusion: Severity Depends on Valve Damage

In summary, the seriousness of rheumatic heart disease is closely linked to the degree of valve damage. Early detection and appropriate medical management are crucial in preventing the progression to more severe forms of the disease. Regular follow-ups with a cardiologist and adherence to prescribed treatments can significantly improve long-term outcomes for patients living with RHD.