What is RHD?

What is Rheumatic Heart Disease (RHD)?

Rheumatic heart disease is the most commonly acquired heart disease in people under 25. Mostly affecting those in low and middle-income countries. It results from damaged heart valves caused by (ARF) an autoimmune inflammatory reaction to strep throat. There is no cure for RHD, the damage is permanent.

  • Rheumatic heart disease is prompted by rheumatic fever an inflammatory condition that affect many connective tissues, especially in the heart, joints, skin or brain.
  • Heart valves can become inflamed and scarred over tim. This can cause the heart valve to contract or leak, making it harder for your heart to work normally.
  • Most commonly starts in school-aged children
  • It is 100% preventable
  • Is not something children are born with
  • If left untreated, RHD can lead to heart valve damage, stroke, heart failure and even death
  • Affects one child in every classroom in Fiji
  • Is the second leading cause of death amongst children and young adults in Fiji
  • In Fiji, around half of all maternal deaths are caused by Rheumatic Heart Disease

How is the heart affected?

  • The heart has 4 sections, they are like “rooms’ also called chambers.
  • The heart valve is like a “door” opening and closing, making sure that blood pumped by the heart flows in one direction only.
  • When these valves are damaged, your blood may either backflow into your hearts chambers or may become stuck and not be able to be pumped out through your valves.
  • This can cause chest pain, breathlessness and tiredness.

Each time a child gets rheumatic fever, the risk of damage to their heart increases. If a child’s heart valve is damaged from an earlier attack, then the damage may get worse with recurrent attacks.

a normal healthy heart
a heart affected by ARF

THIS IS WHY IT IS VERY IMPORTANT TO PREVENT OUR CHILDREN AND YOUNG PEOPLE FROM HAVING ANOTHER ATTACK.

Symptoms

Symptoms of rheumatic heart disease depend on the extent of the valve damage and its severity. Symptoms may not show for many years until the valve damage becomes severe.
Symptoms may include:

  • Shortness of breath (especially when active or lying down)
  • General weakness (fatigue)
  • Palpitations
  • Stroke
  • Chest pain
  • Heart murmur

Initial symptoms of RHD are also the symptoms of early heart failure.

Diagnosis

Early diagnosis of RHD is very important so that secondary prophylaxis can start as soon as possible to help prevent the progression of the valve disease.

Dr. James Auto facilitating an echo session in Rotuma during an community outreach program in collaboration with the MoHMS

Echo (Echocardiography) is an essential procedure to confirm the diagnosis and detect any progression of the damage to the heart valves. We can find kids with early RHD through echo-screening which is a procedure that involves taking a movie of the heart. It’s simple, its painless, and takes about 2 minutes.

Types of Heart Valves affected by Rheumatic Heart Disease:

  1. Mitral Valve – mostly affected tallying 90% cases of RHD
  2. Aortic Valve – 2nd most common usually its associated with the mitral valve
  3. Tricuspid & Pulmonary Valves – rarely gets affected.

Prevention

The major interventions for the prevention and control of RHD include:

1. Primordial prevention

  • Reducing the risk factors of strep infection, ARF and RHD.

This focuses on:

  1. hygiene,
  2. access to medical care and
  3. living conditions.

2. Primary Prevention

Treating sore throats due to Group A strep with antibiotics is the key to reducing the rate of ARF and RHD.

The aim is to:

  1. identify and treat strep infection of the throat and skin sores in those individuals most at risk of ARF (school aged children) and
  2. kill the bacterium with antibiotic treatment before it leads to acute rheumatic fever.

3. Secondary prevention

  • The continuous administration of penicillin for those who have had ARF and for those with RHD.
  • Secondary prevention of further episodes of ARF is a priority. It is the continuous administration of regular Benzathine Penicillin to people with previous attack of Acute Rheumatic Fever.
  • Purpose is to prevent strep infection and the development of recurrent attack of ARF
  • Benzathine Penicillin are given by injection every 3 or 4 weeks depending on severity of the disease to protect the person from future Strep A infections

4. Tertiary prevention

  • Aims to avoid early death and includes the medical management of severe RHD and Heart valve surgery