Rheumatic Heart Disease: Which Parts of the Heart Does It Affect?

Rheumatic heart disease (RHD) is a long-term condition that results from damage to the heart valves caused by rheumatic fever. This illness primarily affects the mitral valve, followed by the aortic valve, and less commonly the tricuspid and pulmonary valves. The symptoms and severity of RHD can vary widely, depending on which valves are affected and the extent of the damage.

Impact on the Mitral Valve

One of the most commonly affected valves in rheumatic heart disease is the mitral valve, which is located between the left atrium and the left ventricle. Damage to this valve can result in either mitral regurgitation (leakage of blood backward into the atrium) or mitral stenosis (narrowing of the valve opening). As the condition progresses, patients may experience symptoms such as shortness of breath, fatigue, and fluid buildup in the lungs, known as pulmonary edema. In more severe cases, patients may also cough up blood, a condition referred to as hemoptysis.

Effects on the Aortic Valve

When rheumatic fever affects the aortic valve, it can lead to aortic regurgitation or aortic stenosis. These conditions can cause symptoms such as chest pain (angina), dizziness, fainting (syncope), and signs of heart failure. In extreme cases, severe aortic valve dysfunction may lead to sudden cardiac death. Early detection and monitoring are crucial to managing these complications effectively.

Other Heart Structures Involved

While the mitral and aortic valves are the most frequently affected, rheumatic heart disease can also involve the tricuspid and pulmonary valves, although to a lesser extent. In addition, many patients with RHD develop complications such as atrial fibrillation—an irregular and often rapid heart rate that can increase the risk of stroke. This makes anticoagulant therapy an important part of treatment for many patients.

Treatment Options for Rheumatic Heart Disease

In the early stages of the disease, management focuses on preserving heart function, preventing infections (especially streptococcal infections), and avoiding activities that place extra strain on the heart. As the condition progresses and heart failure develops, treatment may include medications such as diuretics, vasodilators, and inotropic agents to support heart function.

When valve damage becomes severe, surgical intervention may be necessary. Procedures such as valve repair (valvuloplasty) or valve replacement (with either mechanical or biological prosthetic valves) can significantly improve quality of life and survival rates. Patients with associated atrial fibrillation often require long-term anticoagulation therapy to reduce the risk of stroke.

Importance of Specialized Care

Given the complexity of rheumatic heart disease, it is essential for patients to receive care from specialized cardiology centers. A comprehensive and individualized treatment plan, combined with regular follow-ups and lifestyle modifications, can help manage symptoms and prevent life-threatening complications.