If you want to prevent Rheumatic Heart Disease, don’t ignore Rheumatic Fever let it progresses into the deadly disease.
Rheumatic Hear Disease is a complication of Rheumatic Fever. If rheumatic fever damages the valves of the heart, Rheumatic Heart Disease will occur. The permanent injury of the valves of the heart can lead to various complications and is potentially life-threatening. Learning about both conditions and how to identify them will help prevent them from happening.
What is Rheumatic Fever?
Rheumatic Fever usually occurs after a person is infected with GABHS or group A beta-haemolytic streptococcal bacteria. These infection is common in the pharynx (pharyngitis) in most children, making most children susceptible to it. About 39% of patients with rheumatic fever may acquire numerous forms of pancarditis with related insufficiency of the heart valves, pericarditis, failure of the heart and even bereavement. If it progresses to chronic RHD, the person may acquire valve stenosis with various degrees of atrial dilation, regurgitation, ventricular dysfunction and arrhythmias. Rheumatic Fever and RHD do not just affect children, adults are also at risk for developing the condition. In fact, it is still the primary cause of valve replacement and valve stenosis among adults.
The organism that causes Rheumatic Fever can attach itself to epithelial cells of the pharynx and a number of other parts of the upper respiratory system. They generate a succession of enzymes enabling them to invade and damage their targeted human tissues. An incubation phase of 2-4 days is necessary for the microorganisms to bring forth a heightened inflammatory response and fever, sore throat, headache, malaise, elevated leukocyte levels and sore throat will appear within 3-5 days.
About 3% cases of pharyngitis can lead to Rheumatic Fever after the infection has resolved. Even if a person only has acute Rheumatic Fever and has been treated, pharyngitis can still reactivate it. Pharyngitis can spread through direct contact with respiratory or oral secretions and the transmission of the infection is increased by crowded living circumstances. The microorganisms may linger for the duration of several weeks and may dole out a reservoir to transmit the infection to others.
What is the Jones Criteria?
Diagnosing Rheumatic Fever requires a tool to assess the patient. The Jones Criteria is utilized to confirm the incidence of this condition. A definite diagnois involves the presence of two major or one major plus two minor criteria signs in the patient along with the evidence of a latest GABHS infection.
The Major Criteria of this tool includes:
- Carditis – may involve all cardiac tissue layers concerned (endocardium, myocardium, epicardium and pericardium) and a changing murmur can be heard upon auscultation. Mitral regurgitation and aortic insufficiency may occur;
- Polyarthritis – the migrating type of arthritis that usually affect the knees, wrist (See: Wrist pain) and elbows (See: Elbow pain) with a painful sensation;
- Sydenham’s chorea – also called as St. Vitus dance (abrupt purposeless movements);
- Erythema maginatum – a non-pruritic rash that are seen on the trunk and adjacent extremities; and
- Subcutaneous nodules – lunps located over the tendons and bones and are firm and painless.
The Minor Criteria involves fever, arthralgia, preceding rheumatic fever; acute reactants phase (elevated ESR and CRP or Cr-reactive protein) and long-standing P-R intervals on the ECG result.
How does Rheumatic Heart Disease Progresses?
The causative agent that is involved in this disease is GABHS, as mentioned earlier. It is a gram positive bacterium that colonizes the oropharynx and skin. The patient’s exposure to these bacteria will enable the immune system to produce antibodies against it. The Beta lymphocytes will generate a bacteria marker that will form the permanent antibodies to combat the bacteria in case of another exposure to it.
The main problem for this condition is that the GABHS’ M proteins genotype is similar to the various components of the kidneys and heart. Since the similarities are evident with the causative agent and the normal tissues of the human body, the antibodies won’t be able to determine the difference between the normal tissues and bacteria; therefore, they’ll end up destroying the normal tissues of the heart especially the valves.
Rheumatic Heart Disease can produce pancarditis and the occurrence of endocarditis can be manifested by the insufficiency of the valves. Mitral valves are commonly affected and the aortic valve has the second post for this condition.
What are the Classifications of Rheumatic Heart Disease?
There are two identified classifications for Rheumatic Heart Disease. The Acute and Chronic types are classified according to the complications that the disease presents. Acute RHD shows an evidence of rheumatic fever that can be termed as rheumatic carditis, a component of the Jones criteria (major). It is often self limiting and resolves without sequelae. Chronic RHD presents a long term complication that is associated to residual cardiac injuries specifically the damage of the valves. It can manifest for several years subsequent to the acute attack. Repeated strep infection can occur for persons who don’t strictly follow the treatment regimen will add supplemental damages to the valve. When the valves are damaged, the possibility of the patient to have heart failure is heightened.