Rheumatic Heart Disease

Rheumatic heart disease (RHD) is a condition in which permanent damage to heart valves is caused by rheumatic fever. Rheumatic fever begins with a strep throat from streptococcal (STREP'to-KOK'al) infection. As many as 39% of patients with acute rheumatic fever may develop varying degrees of pancarditis with associated valve insufficiency, heart failure, pericarditis, and even death.

With chronic rheumatic heart disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic rheumatic heart disease remains the leading cause of mitral valve stenosis and valve replacement in adults in many countries including in Indonesia.

# What are the symptoms of rheumatic heart disease?

The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage. The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage.

* Fever.
* Weight loss.
* Fatigue.
* Stomach pains.
* Joint inflammation - including swelling, tenderness, and redness over multiple joints. The joints affected are usually the larger joints in the knees or ankles. The inflammation "moves" from one joint to another over several days.
* Small nodules or hard, round bumps under the skin.
* A change in your child's neuromuscular movements (this is usually noted by a change in your child's handwriting and may also include jerky movements).
* Rash (a pink rash with odd edges that is usually seen on the trunk of the body or arms and legs).


# How to treat of rheumatic heart disease :

Medical therapy is directed toward eliminating the group A streptococcal pharyngitis (if still present), suppressing inflammation from the autoimmune response, and providing supportive treatment for congestive heart failure. But the specific treatment for rheumatic heart disease will be determined by your physician based on:

1. your overall health and medical history
2. extent of the disease
3. your tolerance for specific medications, procedures, or therapies
4. expectations for the course of the disease
5. your opinion or preference

Since rheumatic fever is the cause of rheumatic heart disease, the best treatment is to prevent rheumatic fever from occurring. Oral penicillin V remains the drug of choice for treatment of group A streptococcal pharyngitis. When oral penicillin is not feasible or dependable, a single dose of intramuscular benzathine penicillin G is therapeutic. For patients who are allergic to penicillin, administer erythromycin or a first-generation cephalosporin.

Other options include clarithromycin for 10 days, azithromycin for 5 days, or a narrow-spectrum (first-generation) cephalosporin for 10 days. To reduce inflammation, aspirin, steroids, or non-steroidal medications may be given. Surgery may be necessary to repair or replace the damaged valve.

# Can Rheumatic Heart Disease be Prevented?

The best way to prevent rheumatic heart disease is to seek immediate medical attention to a strep throat and not let it progress to rheumatic fever. The Nurses also have a role in prevention, primarily in screening school-aged children for sore throats that may be caused by Group A streptococci(especially Group A β Hemolytic Streptococcus pyogenes).

Persons who have previously contracted rheumatic fever are often given continuous (daily or monthly) antibiotic treatments, possibly for life, to prevent future attacks of rheumatic fever and lower the risk of heart damage.