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Please add the profiles of those who have or had or died of Rheumatic Heart Disease or Rheumatic Fever or a resulting complication.
Rheumatic heart disease (RHD)– heart muscles and valves damage due to rheumatic fever caused by Streptococcus pyogenes a group A streptococcal infection. Rheumatic heart disease describes a group of short-term (acute) and long-term (chronic) heart disorders that can occur as a result of rheumatic fever. One common result of rheumatic fever is heart valve damage. This damage to the heart valves may lead to a valve disorder.
Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain. The disease typically develops two to four weeks after a streptococcal throat infection. Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and occasionally a characteristic non-itchy rash known as erythema marginatum. The heart is involved in about half of cases. Damage to the heart valves, known as rheumatic heart disease (RHD), usually occurs after repeated attacks but can sometimes occur after one. The damaged valves may result in heart failure, atrial fibrillation and infection of the valves.
Rheumatic fever may occur following an infection of the throat by the bacterium Streptococcus pyogenes. If the infection is untreated rheumatic fever can occur in up to three percent of people.
Rheumatic fever occurs in about 325,000 children each year and about 33.4 million people currently have rheumatic heart disease. Those who develop RF are most often between the ages of 5 and 14, with 20% of first-time attacks occurring in adults. The disease is most common in the developing world and among indigenous peoples in the developed world. In 2015 it resulted in 319,400 deaths down from 374,000 deaths in 1990. Most deaths occur in the developing world where as many as 12.5% of people affected may die each year. Descriptions of the condition are believed to date back to at least the 5th century BCE in the writings of Hippocrates. The disease is so named because its symptoms are similar to those of some rheumatic disorders.
Risk Factors: Factors that can increase the risk of rheumatic fever include:
- Family history. Some people carry a gene or genes that might make them more likely to develop rheumatic fever.
- Type of strep bacteria. Certain strains of strep bacteria are more likely to contribute to rheumatic fever than are other strains.
- Environmental factors. A greater risk of rheumatic fever is associated with overcrowding, poor sanitation and other conditions that can easily result in the rapid transmission or multiple exposures to strep bacteria.
Epidemiology
About 33 million people are affected by rheumatic heart disease with an additional 47 million having asymptomatic damage to their heart valves. As of 2010 globally it resulted in 345,000 deaths, down from 463,000 in 1990.
In Western countries, rheumatic fever has become fairly rare since the 1960s, probably due to the widespread use of antibiotics to treat streptococcus infections. While it has been far less common in the United States since the beginning of the 20th century, there have been a few outbreaks since the 1980s. Although the disease seldom occurs, it is serious and has a case-fatality rate of 2–5%.
Rheumatic fever primarily affects children between ages 5 and 17 years and occurs approximately 20 days after strep throat. In up to a third of cases, the underlying strep infection may not have caused any symptoms.
Rheumatic heart disease (RHD) is the most common acquired heart disease in children in many countries of the world, especially in developing countries. The global burden of disease caused by rheumatic fever currently falls disproportionately on children living in the developing world, especially where poverty is widespread.
The global burden of disease caused by rheumatic fever and RHD currently falls disproportionately on children and young adults living in low-income countries and is responsible for about 233,000 deaths annually.
At least 15.6 million people are estimated to be currently affected by RHD with a significant number of them requiring repeated hospitalization and, often unaffordable, heart surgery in the next five to 20 years.
The worst affected areas are sub-Saharan Africa, south-central Asia, the Pacific and indigenous populations of Australia and New Zealand.
Up to 1 per cent of all schoolchildren in Africa, Asia, the Eastern Mediterranean region, and Latin America show signs of the disease.
The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3%. The incidence of recurrence with a subsequent untreated infection is substantially greater (about 50%). The rate of development is far lower in individuals who have received antibiotic treatment. Persons who have suffered a case of rheumatic fever have a tendency to develop flare-ups with repeated strep infections.
The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first three to five years after the first episode. Recurrent bouts of rheumatic fever can lead to valvular heart disease. Heart complications may be long-term and severe, particularly if valves are involved. In countries in Southeast-Asia, sub-saharan Africa, and Oceania, the percentage of people with rheumatic heart disease detected by listening to the heart was 2.9 per 1000 children and by echocardiography it was 12.9 per 1000 children.
Rheumatic fever is rare these days in the United States and other developed countries. Heart damage it causes usually doesn’t show up for years, but it’s something people need to share with their doctors for the rest of their lives as part of their medical histories. They should also get regular heart exams
Complications
- Inflammation caused by rheumatic fever can last a few weeks to several months. In some cases, the inflammation causes long-term complications.
- Rheumatic heart disease is permanent damage to the heart caused by rheumatic fever. It usually occurs 10 to 20 years after the original illness. Problems are most common with the valve between the two left chambers of the heart (mitral valve), but the other valves can be affected. The damage can result in:
- Valve stenosis. This narrowing of the valve decreases blood flow.
- Valve regurgitation. This leak in the valve allows blood to flow in the wrong direction.
- Damage to heart muscle. The inflammation associated with rheumatic fever can weaken the heart muscle, affecting its ability to pump.
- Damage to the mitral valve, other heart valves or other heart tissues can cause problems with the heart later in life. Resulting conditions can include:
- An irregular and chaotic beating of the upper chambers of the heart (atrial fibrillation)
- An inability of the heart to pump enough blood to the body (heart failure)
For Additional Reading:
- Wikipedia - Rheumatic fever
- Heart & Stroke Foundation - Rheumatic heart disease
- Mayo Clinic - Rheumatic fever
- WebMD - Understanding Rheumatic Fever -- the Basics
- World Heart Federation - Rheumatic Heart Disease
- Encyclopedia.com - Rheumatic Fever
- Indian Journal of Medical Research - Rheumatic fever & rheumatic heart disease: The last 50 years
- The Mercury News - Bill Paxton’s death: Was heart condition linked to childhood illness?
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