Pathophysiology of Rheumatic Heart Disease

Rheumatic heart disease affects the heart valves. Heart valves are structures that regulate the unidirectional bloodflow through the four chambers of the heart. Along the way, valves open or close depending on the pressure on each side. As blood flows, bacteria can infect the heart valves, leading to symptoms such as irregular heartbeat, valvular stenosis or narrowing, infection, arthritis, movement disorders, stomach pains, rashes, clots and low blood count.

The Invader

• Rheumatic fever's most dangerous complication is rheumatic heart disease . Bacteria called Streptococcus pyogenes lurk in your body and attack skin cells lining the nose, throat and windpipe causing sore throat, headache, fever and fatigue. Without proper treatment of rheumatic fever, the disease progresses to rheumatic heart disease and leads to an autoimmune attack on your heart's valves. This means that your body begins to attack the narrowing structures in the heart, wreaking havoc on the organ.

Attacks on the Heart

• Your heart contains three layers. The outer layer is a sac-like structure called the pericardium. The middle layer of muscle is the myocardium. The inner layer is the endocardium. When your immune system begins to attack the heart, it may affect any or all of the three layers; this is called pancarditis. An infection of the pericardium is called pericarditis. Myocarditis is an infection of your myocardium and specific areas of inflammation called Aschoff bodies occur in this area. This inflammation affects your heart's electrical activity, and you develop a strange heart rhythm called an arrythmia. An infection of the endocardium is known as endocarditis and the heart valves become involved this time. This effects blood flow through your heart and oxygenation through your body.

Valves Involved

• According to the website Emedicine, rheumatic heart disease leads mostly to mitral stenosis 99 percent of the time. Remember, valves are like doors that open and close depending upon the pressure on each side. With mitral stenosis, blood continues to flow in one direction, but because of the stenosis, or narrowing, less blood moves through the heart.

Population Targeted

• Children are more likely to get rheumatic fever and develop rheumatic heart disease than are adults. The disease is spread through coughing and sneezing. According to the website Emedicine, adults are not immune and rheumatic heart disease occurs in 20 percent of all reported cases. Rheumatic heart disease targets men and women equally.

Treatment

• To stop rheumatic fever from transforming into rheumatic heart disease, you must use antibiotics against Strep pyogenes. Penicillin is the drug of choice. Rheumatic fever is rare nowadays since penicillin is so easily accessible. Rheumatic heart disease has therefore declined but it does exist, especially in underdeveloped countries.