Rheumatic Heart Disease in Children

Rheumatic heart disease is permanent damage to the heart valves caused by rheumatic fever. Rheumatic fever can develop if someone with a type of strep throat caused by group A beta-hemolytic streptococcus bacteria (GAS) does not receive proper antibiotic treatment. The American Heart Association says that GAS is the most common type of bacterial infection of the throat. According to the American Heart Association, most cases of rheumatic fever occur in children ages 5 to 15, so it is important for parents to be aware of the risk of rheumatic heart disease.

History

• The development of penicillin in the 1950s greatly reduced the number of cases of rheumatic heart disease. According to the American Heart Association, about 15,000 people died of rheumatic heart disease in 1950 in the U.S.; in 2005 that number had dropped to 3,365. Tragically, rheumatic heart disease is still the leading cause of heart-related death in young people in developing countries.

Symptoms

• A child with strep throat will usually have a sudden onset of a sore throat, painful swallowing, headache and fever. Children with strep throat may also have redness of the throat/tonsils, abdominal pain, nausea or vomiting.

  If a child develops rheumatic fever, she may have joints that are painful, swollen and red; pain that moves from one joint to another; shortness of breath; skin rashes; fatigue; fever and small, painless bumps under the skin. According to the American Heart Association, these symptoms usually begin about two or three weeks after the strep throat.

  Rheumatic fever can lead to inflammation of the heart valves, which can lead to permanent scarring and a lifetime of heart problems. Symptoms of rheumatic heart disease depend on the type and severity of the damage, and can include chest pain, lightheadedness and shortness of breath.

Diagnosis

• The only way to know for certain if a sore throat is caused by group A strep is by doing a throat culture. Your child's physician may suspect group A strep based on his symptoms. Rheumatic fever is diagnosed based on a child's symptoms. If your child's physician suspects rheumatic heart disease following a bout of rheumatic fever, your child will need to be evaluated by a cardiologist who will run tests, such as an echocardiogram, to check for heart damage. A child with rheumatic heart disease may also develop a heart murmur that a physician can hear with a stethoscope.

Treatment

• Physicians prescribe antibiotics to treat strep throat. Proper antibiotic treatment will usually cure strep throat before it progresses into rheumatic fever.

  If a child develops rheumatic fever, her physician will usually prescribe an injection of a long-acting antibiotic to treat the bacterial infection, along with high doses of anti-inflammatory medications. Physicians will also usually prescribe bed rest for a child with rheumatic fever, and strict bed rest (only getting up to use the restroom) for a child with suspected inflammation of the heart. Some people with rheumatic fever need to take antibiotics for the rest of their lives to prevent additional heart damage.

  Treatment of rheumatic heart disease depends on the severity of the damage. People with valve damage generally need to take antibiotics before and after surgeries and dental appointments for the rest of their lives, to prevent infection. Some people with rheumatic heart disease only need to be monitored for changes in their condition, while others may need medication. People with more severe damage may need surgery to put a stent in a heart valve, or even surgical valve replacement.

Considerations

• Since antibiotics are so effective for treating strep throat, there is no need to panic if your child develops a sore throat. A child with symptoms of strep throat should see his physician right away, and parents need to make sure that their child takes the prescribed antibiotic as directed until it is all gone, even after he feels better. Although rheumatic heart disease is very serious and potentially deadly, it is entirely preventable with proper medical care.