The last topic on our overview of cardiovascular diseases will focus on rheumatic heart disease (RHD).

RHD still remains a significant cause of morbidity and mortality particularly in low- and middle-income countries. It causes close to 300 000 deaths per year. This disease results from damage of the heart valves that is caused by bouts of rheumatic fever.

Rheumatic fever mainly affects children and adolescents. it is common in overcrowded places where there is poverty and lack of access to healthcare. It starts off as a throat infection that is caused by group A streptococcus. In some people, repeated streptococcus  infections causes the immune system to react against the tissues of the body including inflaming and scarring the heart valves. This is what is referred to as rheumatic fever.

The symptoms of rheumatic fever includes; fever, painful joints especially knees ankles, elbows and wrists, fatigue, jerky uncontrollable body movements, painless nodules under the skin near joints and a skin rash. A heart murmur can also be heard when listening to the heart.

The damage to the heart can then over a period of time result in RHD. This then leads to either leakage or blockage of the heart valves. Symptoms of heart valve damage that may be due to RHD includes; chest pain or discomfort, shortness of breath, swelling of the stomach, hands or feet, fatigue and rapid or irregular heartbeat.

The diagnosis of RHD can be made by doing blood tests to confirm previous streptococcal infection. A scan of the heart is then done to confirm and measure the degree of damage to the heart valves. Other tests that may be necessary include an ECG which detects abnormal heart rhythms and a chest Xray. Treatment of RHD depends on the severity of the disease. In very severe cases surgery is required to repair or replace the valve. Mild to moderate cases can be treated with medications to alleviate symptoms . The other important aspect in preventing RHD is treating throat infections due to streptococcus with antibiotics, in order to prevent rheumatic fever. Those that have had  rheumatic fever need a long term course of prophylactic antibiotics to prevent recurrent episodes of rheumatic fever.

Cardiovascular disease contributes to significant morbidity and mortality as we have discussed over the past few weeks. The take home message however should be that the presenting symptoms are few and common amongst the various conditions. Any of the following; chest pain, shortness of breath on exertion, shortness of breath while lying flat and palpitations should alert one of a possibility of underlying cardiovascular disease and one must seek help with appropriate health personnel.


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