Rheumatic Heart Disease: Recognizing the Common Symptoms and Signs

Rheumatic heart disease (RHD) is a long-term complication that arises from untreated or inadequately treated rheumatic fever, often leading to permanent damage to the heart valves. This condition can cause various symptoms depending on the severity and the specific heart valve affected. Understanding the key signs can help in early diagnosis and better management of the disease.

Heart Failure-Related Symptoms

One of the most common manifestations of rheumatic heart disease is heart failure. Patients may experience varying degrees of dyspnea (shortness of breath), particularly during physical exertion. Other related symptoms include paroxysmal nocturnal dyspnea—where individuals wake up suddenly due to breathing difficulties—and orthopnea, which is difficulty breathing when lying flat, often requiring the use of multiple pillows for comfort.

Signs of Pulmonary Involvement

Acute pulmonary edema can occur in advanced stages of the disease, causing symptoms such as coughing, expectoration, and even hemoptysis (coughing up blood). These symptoms are often linked to increased pressure in the pulmonary circulation due to left-sided heart valve dysfunction. Additionally, enlargement of the left atrium may compress the recurrent laryngeal nerve, leading to persistent hoarseness and a chronic cough.

Heart Rhythm Disturbances

Atrial Fibrillation and Palpitations

Heart rhythm abnormalities, particularly atrial fibrillation, are frequently observed in patients with rheumatic heart disease. This irregular and often rapid heart rate can result in sensations of palpitations, fatigue, and reduced exercise tolerance. It also increases the risk of stroke if left untreated.

Complications from Aortic Valve Damage

When rheumatic fever affects the aortic valve, it can lead to either stenosis (narrowing) or regurgitation (leakage). These conditions may cause symptoms such as dizziness, fainting spells (syncope), and angina—a type of chest pain caused by reduced blood flow to the heart muscle. In severe cases, especially with critical aortic stenosis, there is a risk of sudden cardiac death, making timely diagnosis and treatment crucial.

Recognizing these symptoms early and seeking medical attention can significantly improve the prognosis for individuals with rheumatic heart disease. Regular cardiac evaluations, especially in regions where rheumatic fever is prevalent, are essential to prevent long-term complications.