Rheumatic Heart Disease

PROF.JEENATH JUSTIN DOSS.K M.Sc. NURSING.

HOD MEDICAL SURGICAL NURSING
JOITIBA COLLEGE OF NURSING
LCIT CAMPUS,
VISNAGAR TA.,BHANDU PO.,
MEHSANA DIST.
NORTH GUJARAT-384120
PH: +919558159445
jeenath4u@gmail.com

Rheumatic heart disease (RHD) is the most common acquired heart disease in children in many
countries of the world, especially in developing countries. The global burden of disease caused
by rheumatic fever currently falls disproportionately on children living in the developing world,
especially where poverty is widespread.
RHD is a chronic heart condition caused by rheumatic fever that can be prevented and
controlled. Rheumatic fever is caused by a preceding group A streptococcal (strep) infection.
Treating strep throat with antibiotics can prevent rheumatic fever. Moreover, regular antibiotics
(usually monthly injections) can prevent patients with rheumatic fever from contracting further
strep infections and causing progression of valve damage.
Neglected disease of poverty
Rheumatic heart disease affects children and young people living in conditions of poverty, poor
sanitation and overcrowding. Practically eliminated in wealthy countries, it is still common in
Africa, Asia and the Pacific. Over 15 million people around the world suffer from the condition,
which kills hundreds of thousands of people a year and is the most common acquired heart
disease found among children and young people in developing countries.

Rheumatic heart disease is often missed in its early stages. It begins with a common throat
infection caused by streptococcus bacteria (strep throat), which in some children sets off an
abnormal immune reaction that damages heart valves. This reaction, called rheumatic fever, has
symptoms that are vague and easily confused with other conditions.

People affected often look and feel healthy again once their outward symptoms are resolved, but
with further streptococcal infections the rheumatic fever returns, worsening their heart damage.
Often rheumatic heart disease is only detected when it is so advanced that only expensive and
complicated heart surgery can save the person's life.

Consequences of rheumatic heart disease

Acute rheumatic fever primarily affects the heart, joints and central nervous system. The major
importance of acute rheumatic fever is its ability to cause fibrosis of heart valves, leading to
crippling valvular heart disease, heart failure and death.
The decline of rheumatic fever in developed countries is believed to be the result of improved
living conditions and availability of antibiotics for treatment of group A streptococcal infection.
Overcrowding, poor housing conditions, undernutrition and lack of access to healthcare play a
role in the persistence of this disease in developing countries.

Rheumatic heart disease facts

The global burden of disease caused by rheumatic fever and RHD currently falls
disproportionately on children and young adults living in low-income countries and is
responsible for about 233,000 deaths annually (World Heart Federation)

At least 15.6 million people are estimated to be currently affected by RHD with a
significant number of them requiring repeated hospitalization and, often unaffordable,
heart surgery in the next five to 20 years.

The worst affected areas are sub-Saharan Africa, south-central Asia, the Pacific and
indigenous populations of Australia and New Zealand.

Up to 1 per cent of all schoolchildren in Africa, Asia, the Eastern Mediterranean region,
and Latin America show signs of the disease.

Treatment
Primary prevention of acute rheumatic fever (the prevention of initial attack) is achieved by
treatment of acute throat infections caused by group A streptococcus. This is achieved by up to
10 days of an oral antibiotic (usually penicillin) or a single intramuscular penicillin injection.
People who have had a previous attack of rheumatic fever are at high risk for a recurrent attack,
which worsens the damage to the heart. Prevention of recurrent attacks of acute rheumatic fever

is known as secondary prevention. This involves regular administration of antibiotics, and has to
be continued for many years. Secondary prevention programmes are currently thought to be
more cost effective for prevention of RHD than primary prevention and may be the only feasible
option for low- to middle-income countries in addition to poverty alleviation efforts.
Surgery is often required to repair or replace heart valves in patients with severely damaged
valves, the cost of which is very high and a drain on the limited health resources of poor
countries.