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RHEUMATIC HEART DISEASE (RHD)

RHEUMATIC HEART DISEASE (RHD) remains a leading cause of morbidity and mortality among young adults in the developing world, accounting for at least 345,000 deaths annually

Before we dig into Rheumatic Heart Disease, it is important to understand Acute Rheumatic Fever, as this illness is the precursor to Rheumatic Heart Disease.

What is Acute Rheumatic Fever

  • Acute Rheumatic Fever (ARF) is a condition which occurs when your body sends out an autoimmune response when you have a group A streptococcus (strep) bacterial infection.In simpler terms, if you have a strep infection, your immune system will instead create an inflammation-like response in your body, which can result in some unpleasant symptoms.

    Symptoms of Acute Rheumatic Fever

    • Sore throat
    • Skin sores
    • Fever
    • Jerky body movements
    • Skin rash on your abdomen and chest
    • Joint pain and swelling around the knees, feet and ankles
    • Heart swelling which can lead to chest pain and fluid build-up in the legs
    • Nodules (painless lumps) on areas such as wrists, elbows, knees, ankles and even on sections of your spine

    ARF is often seen in children aged between 5-14 years of age however it can be known to reoccur in people in their 40s.

What is Rheumatic Heart Disease?

Rheumatic Heart Disease is a condition where you have long-lasting heart valve damage after one or more illness episodes of ARF.

One or more of your heart valves may be left with scarring or even stretching, leading to issues with your blood flowing properly. When these valves are damaged, your blood may either backflow into your heart’s chambers or may become stuck and not be able to be pumped out through your valves.

It is estimated that at least 15.6 million people worldwide are living with RHD, with the burden tending to be within developing nations.

In Uganda, RHD is the most common cause of heart disease in young adults.  As is true in many underserved areas, Ugandan patients tend to present late in the disease course, and almost half present with a complication.

Complications

There are a number of complications which have been linked to RHD:

    • Heart Failure, a condition where the heart’s pumping function is impaired.
    • Infective endocarditis, which is an infection to your damaged heart valves
      Stroke, as clots can form in your enlarged or damaged heart valves and then travel to your brain.
    • Arrhythmias (such as AF), where your heart is in an abnormal rhythm
    • Pregnancy complications
    • Early death in young adults
    • Disability as well reduced quality of life

Symptoms of RHD

The signs and symptoms of RHD appear to be a combination of infection-like symptoms as well as symptoms of Heart Valve Disease.

Here are some of the common signs and symptoms of RHD:

  • Fever
  • Shortness of breath
  • Oedema (swelling of fluid) in the ankles and legs
  • Fainting
  • Orthopnea (when you cannot lay down due to breathing problems)
  • Chest pain
  • Palpitations