Rheumatic Heart Disease: Understanding Its Causes and Impact

Rheumatic heart disease (RHD) is a long-term condition that primarily arises as a complication of untreated or inadequately treated rheumatic fever. This type of fever is often triggered by an infection with group A Streptococcus bacteria, also known as Streptococcus pyogenes. These bacteria are responsible for common infections such as strep throat and scarlet fever, but if left unchecked, they can lead to more severe systemic conditions like rheumatic fever.

How Does Rheumatic Fever Lead to Heart Damage?

When the body is infected with group A Streptococcus, the immune system responds by producing antibodies to fight the bacteria. However, in some cases, these antibodies mistakenly attack the body's own tissues—particularly those in the joints, skin, brain, and most critically, the heart. This autoimmune response is what leads to rheumatic fever, which can cause inflammation and damage to the heart valves over time.

The Role of Heart Valve Damage in RHD

One of the most common effects of rheumatic heart disease is damage to the mitral valve, which is located between the left atrium and left ventricle. This damage can result in mitral stenosis, where the valve opening becomes narrowed, restricting blood flow. In addition to the mitral valve, the tricuspid valve—found on the right side of the heart—can also be affected, leading to either stenosis or regurgitation (leakage of blood backward through the valve).

When Is Surgical Intervention Necessary?

If the valve damage progresses to a severe stage, it can significantly impair heart function and lead to symptoms like shortness of breath, fatigue, and swelling in the legs and feet. In such cases, surgical treatment may be required. This often involves valve replacement or repair to restore normal blood flow and prevent further complications. The decision to proceed with surgery depends on the severity of the valve disease, the patient's overall health, and the presence of symptoms.

Prevention and Early Detection Are Key

Preventing rheumatic heart disease starts with prompt and complete treatment of streptococcal infections using antibiotics. Regular follow-ups and secondary prophylaxis (continued antibiotic use) are often recommended for individuals who have already experienced one episode of rheumatic fever. Early detection through regular heart check-ups, especially in children and young adults in high-risk populations, can also help in managing the condition before it leads to irreversible heart damage.