Recent Developments in the Treatment of Rheumatic Heart Disease (RHD)

 Rheumatic Heart Disease and Your Health: Post-Diagnosis Precautions and Wellness

Rheumatic heart disease is when heart valves become damaged because of rheumatic fever, an inflammatory response to a bacterial infection. Individuals living in underdeveloped countries without access to antibiotics are at high risk. This disease can cause severe health complications, such as heart failure. The primary methods for treating rheumatic heart disease include medication and surgery. A streptococcal bacterial infection typically affecting children and young adults can cause RHD. The immune system reacts to the streptococcal infection and produces antibodies that attack the heart valves, causing inflammation, scarring, and deformity of the valve leaflets. 

The issue begins when a person experiences rheumatic fever during childhood. It may cause only minor symptoms. The individual may develop joint pain and active rheumatic carditis, which is heart inflammation due to infection. This condition can cause shortness of breath, chest pain, and a high fever. 

Rheumatic heart disease in children can be prevented

Unfortunately, these symptoms tend to be brief and resolve quickly, and since the disease does not typically recur, many parents ignore it. Over time, this can lead to valve stenosis or regurgitation, which skilled cardiac surgeons can impair the heart's ability to function properly and lead to heart failure. Treating streptococcal infections with antibiotics and addressing other risk factors can prevent rheumatic heart disease. Treatment of RHD may involve medications to control symptoms and reduce the risk of complications, such as diuretics to reduce fluid buildup, beta-blockers to slow the heart rate, and anticoagulants to prevent blood clots. In severe cases, cardio surgery can repair or replace damaged heart valves.

What are the symptoms of rheumatic heart disease?

Rheumatic heart disease can cause a variety of symptoms, including:

• Shortness of breath, especially during physical activity or when lying flat
• Chest pain or discomfort
• Heart palpitations, or the sensation of a racing or irregular heartbeat
• Fatigue or weakness, especially during physical activity
• Swelling of the legs or feet
• Fainting or lightheadedness
• Joint pain or swelling (associated with rheumatic fever, which can lead to rheumatic heart disease) 

How is rheumatic heart disease diagnosed?

Doctors diagnose rheumatic heart disease through a variety of tests and procedures, including:

• Physical examination to assess heart function and look for signs of heart damage or inflammation
• Echocardiogram, which uses ultrasound waves to create images of the heart and check for valve damage or other abnormalities
• Electrocardiogram (ECG), which records the electrical activity of the heart to identify any irregularities
• Chest X-ray to check for fluid buildup in the lungs or other signs of heart failure
• Blood tests to look for markers of inflammation or infection
• Doctors examine throat cultures to check for streptococcal bacteria, which can lead to rheumatic fever and rheumatic heart disease.

How is rheumatic heart disease treated?

• Surgeons treat Rheumatic heart disease through medication and, in some cases, surgery.
• Medications may include antibiotics to treat infections, diuretics to reduce fluid buildup, beta-blockers to slow the heart rate, and anticoagulants to prevent blood clots.
• Patients can expect surgery to repair or replace damaged heart valves.
• A surgeon may work for a minimally invasive procedure known as balloon valvuloplasty may be used to widen a narrowed valve.
• Individuals with rheumatic heart disease may also need to make lifestyle changes, such as quitting smoking, adopting a heart-healthy diet, and regularly exercising.
• In addition, individuals with rheumatic heart disease require regular monitoring and follow-up care to manage symptoms and prevent complications.

 

How is heart valve repair performed?

Doctors perform Heart valve repair through open-heart surgery doctors can use MISs.

• To perform heart valve repair, the surgeon places the patient under general anaesthesia and makes an incision in the chest to access the heart.
• The surgeon then uses valuable techniques like reshaping, trimming, or adding tissue to repair the damaged valve.
• Doctors can replace the valve with a prosthetic valve made of either biological or mechanical materials.
• Once the valve is repaired or replaced, the surgeon closes the incision, and the patient may shift to the recovery room. 
• The duration of the surgery and the recovery time can vary depending on the extent of the repair and the overall health. 

 How is heart valve replacement performed?

• A surgeon performs heart valve replacement under general anaesthesia.
• The surgeon makes an incision in the chest to access the heart, removes the damaged valve, and replaces it with a prosthetic valve made of either biological or mechanical materials.
• After replacing the valve, the surgeon closes the incision and monitors the patient in the recovery room.
• In some cases, the surgeon may use minimally invasive techniques for valve replacement, which involve making smaller incisions and causing less damage to surrounding tissues.
• The duration of the surgery and the recovery time can vary depending on the extent of the replacement and the health.

Acute rheumatic fever and rheumatic heart disease

 

 What is the Ross procedure in RHD surgery?

• The Ross procedure is a surgical procedure used to replace a damaged aortic valve.
• During the procedure, the surgeon removes the patient's pulmonary valve and uses it to replace the damaged aortic valve.
• The surgeon replaces the pulmonary valve with a valve from a human donor or a prosthetic valve.
• Cardiothoracic surgeons use this procedure often in younger patients who may outgrow a prosthetic valve and need another replacement later in life.
• The Ross procedure can offer better long-term outcomes and other valve replacement options.
• However, it is a complex procedure that requires a skilled surgeon for all patients.

 

How does rheumatic heart disease affect pregnant women?

Pregnant ladies with rheumatic heart disease are at high risk. During pregnancy, the body produces more blood, making the heart work harder to pump it. RHDs can lead to severe health complications for individuals with damaged heart valves. Additionally, the health of the fetus may also be in danger.

• It can cause heart failure and lead to shortness of breath, fatigue, and swelling in the legs and ankles.
• In severe cases, RHDs can lead to miscarriage, premature birth, or stillbirth.
• Pregnant women with RHDs require close monitoring by healthcare professionals to ensure the best possible outcomes for both the mother and the baby.
• Treatment options may include medication, monitoring and managing symptoms, and surgical interventions.

 

What are the complications of rheumatic heart disease?

Complications of rheumatic heart disease include:

• Abnormal heartbeat (arrhythmia).
• A defective heartbeat in the upper parts of the heart prevents normal blood flow (atrial fibrillation).
• Heart failure means the heart does not pump blood as it should.
• These conditions can increase the risk of stroke or blood clots.

What are the recent developments in the treatment of RHD?

There have been several recent developments in the treatment of rheumatic heart disease (RHD), including:

• Antibiotic prophylaxis: Cardiothoracic surgeons use Antibiotic treatment to prevent streptococcal infections, which can lead to rheumatic fever and subsequent RHD.
• Minimally invasive procedures: MISs involve smaller incisions and less damage to surrounding tissues, resulting in shorter hospital stays and faster recovery times.
• Percutaneous balloon mitral valvuloplasty: Cardiothoracic surgeons may insert a catheter into the heart. They may use an inflated balloon to open the mitral valve, which can relieve symptoms of RHD.
• Tissue-engineered heart valves: Researchers are working to develop heart valves made from a patient's cells, which could reduce the risk of rejection and the need for anticoagulant therapy.
• Improved surgical techniques: Advances in surgical procedures, including robot-assisted surgery, have made heart valve repair and replacement safer and more effective.

These recent developments offer hope for more effective treatments and better outcomes for patients with RHD.

What are the precautions after RHD?

Here are some precautions that doctors recommend after RHD:

• Take all medications as prescribed by the doctor.
• Follow a heart-healthy diet recommended by a doctor or a registered dietitian.
• Exercise regularly under the guidance of the doctor.
• Avoid smoking and limit alcohol intake.
• Get regular check-ups and tests as advised by the doctor.
• The doctor may ask to follow proper antibiotic treatment before and after treatment to prevent infection.
• Maintain good dental hygiene.
• Seek immediate medical attention if any new symptoms or changes in existing symptoms occur.

References:

1. Carapetis, J. R., McDonald, M., Wilson, N. J., & Acute Rheumatic Fever Guidelines Writing Group. (2005). Acute rheumatic fever. The Lancet, 366(9480), 155-168.

2. 1. Remenyi, B., Carapetis, J., Wyber, R., & Taubert, K. (2013). Mayosi BM. Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease. Nature Reviews Cardiology, 10(5), 284-292.

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