Rheumatic Heart Disease

WHAT YOU SHOULD KNOW

Although a variety of abnormal heart conditions fall under the heading of rheumatic heart disease, the majority involve a damaged heart valve that fails to open or close completely, or grows excessively stiff and narrow. Adults sometimes develop this problem, but it typically begins with a bout of rheumatic fever between the ages of four and 18 years. Its effects can last a lifetime.

Causes

Rheumatic fever is a strep infection that sometimes leads to inflammation of the heart and scarring of the heart valves. Scars on a valve may permit leakage, creating a backward flow of blood, or may narrow the opening of the valve, restricting the amount of blood that gets through. Although most symptoms of the strep infection usually clear up within a couple of weeks, inflammation in the heart can persist for several months, leaving the permanent damage that marks this disease.

Signs/Symptoms

The rheumatic fever that triggers this disease is often accompanied by painful joints and involuntary spasms. If inflammation of the heart also sets in, roughly half of its victims will remain unaware of it until years later, when results of the damage begin to surface. At the time of the fever, the most common cardiac symptom is a heart murmur detectable only through a stethoscope. Later, the condition will produce cardiac problems such as constant fatigue, lack of stamina, chest pain, irregular pulse, shortness of breath, and fainting spells.

In children, rheumatic fever causes a surprisingly different set of symptoms. They include nausea, vomiting, stomachache, shortness of breath, and a dry, hacking cough.

Care

Treatment depends on the exact type of rheumatic heart disease you have and its severity. In most cases, blood thinners (Coumadin or aspirin) are prescribed to prevent clots. The doctor may also prescribe beta blockers and calcium channel blockers to slow the heart, and digitalis and other heart drugs to boost its efficiency. Water pills may be needed to counteract the fluid buildup caused by a weakened heart.

Because rheumatic fever sufferers are prone to further attacks and yet more heart damage, you will most likely be prescribed monthly or daily antibiotic treatments, perhaps for life. You'll probably have to restrict your exercise as well.

For severe cases, surgical options are available—the most common being the implantation of an artificial valve or the opening of an excessively narrow valve. A non-surgical procedure, called a balloon valvuloplasty, is yet another choice for those patients who are poor candidates for surgery. This process involves snaking a balloon-tipped catheter through the arteries and into the valve, where the balloon is inflated to open the leaves of the valve.

Risks

The damage typical of rheumatic heart disease can eventually cause congestive heart failure, stroke, and abnormal heart rhythm.

WHAT YOU SHOULD KNOW

• Follow your medication program carefully. The drugs are designed to prevent serious complications.
• Make sure that all healthcare providers are aware of your condition. You will need antibiotic treatment prior to any dental or surgical procedures.
• Work with your physician on an effective exercise program, then follow it daily. Regular exercise strengthens the heart and lowers blood pressure. Walking and golfing, for example, are excellent forms of exercise for those suffering from rheumatic heart disease. However, you should consult your doctor before engaging in other, more rigorous forms of exercise such as basketball or strength training workouts.
• Eat a well balanced, heart-healthy diet low in fat, salt, and cholesterol.
• Maintain a healthy weight. Too much weight can put added stress on your heart.
• Learn to control stress by adopting new ways to relax such as deep breathing exercises, muscle relaxing techniques, meditation, or yoga.
• Get at least seven hours of sleep each night and nap during the day if you feel tired.
• Quit smoking. If you are having trouble quitting, ask your doctor for help or for additional resources that can assist you.
• For more information, contact the American Heart Association at 1-800-AHA-USA1 (242-8721) or 214-373-6300 or visit their website at www.americanheart.org.

Call Your Doctor If...

• You become light-headed, dizzy, sweaty, or nauseated.
• You gain several pounds in one or two days.
• Your blood pressure becomes higher or lower than usual.
• You have trouble breathing.
• You experience chest pain during exercise that doesn't go away with rest.
• Your pulse is faster or slower than usual.
• You begin wheezing.

Seek Care Immediately If...

• You have difficulty breathing.
• You develop a fast or uneven heartbeat.

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