Rheumatic Heart Disease

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RHEUMATIC HEART DISEASE WHAT IS IT?
Rheumatic Heart Disease is the sequelae of
Rheumatic fever which is an infection by a
bacterium (beta hemolytic streptococcus). The
fever affects children or young adults. It
typically presents with fever and joint
inflammations.
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The common joints affected are knee, hip and
elbow. The swelling and pain in joints has a
characteristic fleeting nature. They affect one
joint at a time and seem to migrate from one
joint to another. The joint lesions heal without
any scar.
Rheumatic Valvular Disease is caused by the
immunological reaction of the body which is
misdirected at the valvular tissue. It causes
inflammation and scarring of the heart valves and
result in valve dysfunction stenosis or
regurgitation or a combination. Mitral valve is
affected most. But other valves are also
affected singly or along with mitral valve.
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SYMPTOMS The symptoms of valvular diseases will
vary depending on the type valve, nature of
lesion (block or leak), severity of lesion and
rapidity of progress. Dyspnea or Breathlessness
This is one of the commonest symptom of any type
of valvular disease. From mild to most severe
form this symptom can vary in intensity. Milder
forms present only on exertion while more severe
forms can be present even at rest.
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In very severe types the patient may not be able
to lay down comfortably (Orthopnea). He may also
experience sudden bouts of severe breathlessness
in the night which forces him to wake up with
extreme difficulty in breathing associated with
cough (Paroxysmal Nocturnal Dyspnea or PND).
These extreme forms are most commonly seen in
Mitral valve disease. Palpitation Awareness of
ones own heartbeats is known as Palpitation.
Valve disorders can present with various types of
rhythm disturbances. Extra beats (Premature
atrial / Ventricular Contractions) are quite
common. Atrial Fibrillation is common in Mitral
Stenosis and Mitral Regurgitation.
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Atrial fibrillation (AF) is an abnormal rhythm
where atrial contractions are ineffective and
rapid and ventricular contractions are irregular.
Often presented as palpitation. In valvular
diseases this condition is caused by atrial
dilatation and commonly found in Mitral disease.
Atrial fibrillation causes blood to stagnate in
atria and can cause clots in the atria. This can
lead to Thrombo-Embolism (Migration of small
clots into the circulation causing occlusion of
arteries) It can embolize to legs or abdomen.
When it happens in the brain circulation, the
result is a stroke! So AF is a serious condition w
hich needs to be treated. Patient has to be on
Anticoagulant medications (Blood thinning agents
to prevent clots) until AF is reverted
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Angina Presentation of angina is just like that
in Coronary Artery Disease. This symptom is
common in Aortic Stenosis and can often be
confusing Giddiness Often the presenting symptom
in Aortic lesions. In Aortic stenosis it is seen
early while in Aortic regurgitation it is late
symptom. Non-specific symptoms Patients may
experience extreme tiredness, nausea, loss of
appetite and even weight loss. DIAGNOSING
VALVULAR HEART DISEASE Thorough clinical
evaluation and routine investigations are
mandatory. However the mainstay of diagnosing
valvular heart diseases is an Echocardiography.
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Echo provides accurate information regarding
structure of valve and dimensions of the
chambers. Doppler information is valuable in
calculating the degree of stenosis or
regurgitation. Trans-Esophageal Echocardiography
or TEE can be helpful in planning valve
repairs. TREATMENT Medical Treatment Once the
valve disorder is diagnosed, initial line of
treatment will be medical. Depending on the type
of lesion and severity of the lesion the
treatment also differs. The medicines may
include anti-hypertensive drugs, heart rate
controlling medications, diuretics,
anti-platelets and anti-coagulants.
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In rheumatic valvular diseases, Penicillin
prophylaxis may be given. Patients with Atrial
Fibrillation (AF) should receive
anticoagulants. If the symptoms are relieved by
medications, the treatment can be continued until
the disease progresses to the next stage.
Sometimes in the course of treatment a decision
may have to be taken regarding other treatment
methods like surgery.
Balloon Valvotomy In stenotic lesions of Mitral
or Pulmonary valves, Dilatation of the stenosed
valve by using a special balloon is a favored
treatment. The valve must be soft with out
calcification and pliable. Very hard valves can
not be safely opened with balloon. It may cause
balloon to rupture or valve may tear at an
undesirable location causing severe valve leak.
So the valve anatomy has to be carefully
assessed by Echocardiography.
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Valve Replacement Severe valve disorders that
cannot be treated by other methods may need valve
replacement. Every patient has to be assessed
individually and a careful decision made
regarding replacement. Mitral and Aortic valves
are the commonly affected valves and so the
replacements are also common in these
positions. Variety of valves are available for
replacement. However they can be broadly divided
into two categories. Mechanical Valves and
Bio-prosthetic (Tissue) valves. Mechanical Vs
Bio-prosthetic valves is dealt in another
section. Valve Repair In spite of the tremendous
progress made in the design and structure of
mechanical and tissue valves, the ideal valve
prosthesis is still far from reality. No man
made valve can match the simplicity and
efficiency of natural human valves. Even in
partially defective condition natural valves
function better than the prosthetic ones. In
spite of the tremendous progress made in the
design and structure of mechanical and tissue
valves, the ideal valve prosthesis is still far
from reality. No man made valve can match the
simplicity and efficiency of natural human
valves. Even in partially defective condition
natural valves function better than the
prosthetic ones.
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reserved.