Rheumatic Heart Disease

Rheumatic heart disease is a disease of the heart that is caused by infection with group A beta-hemolytic streptococcus bacteria (GAS). A person can develop rheumatic heart disease if he or she has GAS pharyngitis, which is a specific type of "strep throat," and does not receive proper medical treatment. Rheumatic heart disease begins as an acute inflammation of the heart, and can progress to a chronic disease with permanent damage to the heart. In 2005, rheumatic heart disease killed 3,365 people in the U.S., according to the American Heart Association 2009.

History

• Before the development of penicillin, rheumatic heart disease was a big killer, particularly of children. In 1950 about 15,000 people in the U.S. died of rheumatic heart disease. According to the American Heart Association, proper use of antibiotics has tremendously reduced the number of cases of rheumatic heart disease, although it is still the leading cause of cardiovascular deaths for young people in developing countries.

Features

• GAS strep throat is most often seen in children ages 5 to 15, but people of any age can catch it. The symptoms include a sore throat that usually comes on suddenly, painful swallowing, fever, and headache. Someone with GAS strep throat may also have abdominal pain, nausea, or vomiting. Strep throat is treated with antibiotics, usually penicillin. The only way to know for sure if a sore throat is from GAS is to have a throat culture. If GAS strep throat is not treated, it can progress to rheumatic fever, which sometimes comes with a red rash, swollen, painful joints, bumps on the skin, heart palpitations, or abnormal movements (Sydenham's chorea). Rheumatic fever can affect the heart, causing the heart to become inflamed. The inflammation can lead to permanent scarring of the heart valves.

  When rheumatic fever causes permanent damage to the heart, it is called rheumatic heart disease. Rheumatic heart disease can mean a lifetime of heart problems, and sometimes surgery, such as a heart valve replacement, is necessary. People who have had rheumatic fever are at high risk for developing it again after another GAS infection, even without symptoms.

Treatment

• Strep throat is treated with antibiotics. If strep throat develops into rheumatic fever, the physician will normally prescribe an injection of a long-acting antibiotic to clear up the infection, along with high doses of anti-inflammatory medications to reduce the inflammation in the joints and/or heart. Doctors usually prescribe bed rest, and will monitor the heart for any problems. If the heart is inflamed, the patient is usually put on strict bed rest.

  If rheumatic fever becomes chronic rheumatic heart disease, the patient may need to take antibiotics continuously for life, or before any surgery or visits to the dentist. Each person with rheumatic heart disease needs to have his or her heart function evaluated by a cardiologist to see if surgery or other intervention is necessary.

Prevention/Solution

• Prevention of rheumatic heart disease is always the best course. It is important for people with symptoms of possible strep throat to see the doctor, especially children between five and 15. Anyone who is diagnosed with GAS strep throat needs to finish the entire course of antibiotics prescribed by the doctor, and see the doctor if the symptoms do not go away, or if symptoms get worse.

Considerations

• Most sore throats are caused by viruses or other types of bacteria, and are not GAS strep throat. There is no need to panic over every sore throat. However, if you suspect that you or your child may have strep throat, see a physician and follow his or her directions. We are lucky to have medications that can prevent rheumatic heart disease, and we need to be cautious about strep throat and take possible strep throat seriously.