Rheumatic Heart Disease: Understanding Its Causes and Development

Rheumatic heart disease (RHD) originates from a condition known as rheumatic fever, which typically develops in cold, damp, and crowded environments, especially during the winter and spring months. This illness most commonly affects children between the ages of 5 and 15 and is primarily caused by an untreated or inadequately treated infection with group A Streptococcus bacteria. When diagnosed early and treated properly with penicillin-based antibiotics, rheumatic fever can often be managed effectively. However, if treatment is delayed or inconsistent, the disease may recur within 3 to 5 years after the initial episode.

Progression of Rheumatic Fever to Heart Disease

Over time, repeated episodes of rheumatic fever—often occurring over a period of 10 to 20 years—can lead to long-term damage to the heart valves and associated structures such as the chordae tendineae. This progressive damage results in conditions like valve stenosis (narrowing) or regurgitation (leakage), most commonly affecting the mitral valve, followed by the aortic and tricuspid valves. When this damage becomes chronic and affects heart function, it is classified as rheumatic heart disease.

Structural Changes in Heart Valves

The disease process typically begins with inflammation, edema, and fluid accumulation at the edges and tips of the valve leaflets. As the condition progresses, these changes extend to the base and annulus of the valve, often involving the chordae tendineae and papillary muscles. This leads to fusion and shortening of the valve structures, along with fibrosis, stiffness, curling, and calcification of the leaflets. These structural alterations impair the normal opening and closing of the valves, resulting in either stenosis or insufficiency.

Impact of Mitral Valve Stenosis

Rheumatic heart disease most frequently affects the mitral valve. In cases of mild mitral stenosis where the patient experiences no symptoms, specific treatment may not be required. However, individuals should avoid strenuous physical activity and take preventive measures to reduce the risk of complications such as infective endocarditis or worsening heart failure.

Symptoms and Treatment for Moderate to Severe Stenosis

Patients with moderate to severe mitral stenosis may experience symptoms including shortness of breath, coughing, hemoptysis (coughing up blood), and thromboembolic events. These individuals require prompt medical attention and management of complications. When medications fail to provide adequate relief and surgical intervention becomes necessary, options such as balloon valvuloplasty or open-heart surgery should be considered to restore normal valve function.

Potential Complications of Valve Damage

Mitral stenosis increases the workload on the left atrium, leading to atrial enlargement, arrhythmias—including atrial fibrillation—and the formation of blood clots within the heart chamber. These clots can dislodge and travel through the bloodstream, causing life-threatening events such as stroke (cerebral embolism) or pulmonary embolism. Therefore, early diagnosis and appropriate management are crucial to preventing serious outcomes associated with rheumatic heart disease.