How Does Rheumatic Heart Disease Affect the Valves?

Rheumatic heart disease, although it is steadily declining in developed countries, is still something we encounter in our country: it is the permanent damage that a childhood infection leaves on the heart valves years later. In this article I will describe how rheumatic fever affects the valves.

Rheumatic Fever in Childhood and Cardiac Involvement

Rheumatic fever develops after a throat infection caused by the group A streptococcus bacterium, when the body’s own immune system mistakenly attacks heart tissue as well (the mechanism of molecular mimicry); the immune cells produced against the bacterium can, because of structural similarity, also target heart valve tissue. In infections that are not adequately treated or that recur, this process leads to permanent, progressive damage to the valves.

Mitral Stenosis and the “Fish Mouth” Appearance

The valve most often affected by rheumatic disease is the mitral valve; over the years the valve leaflets thicken, stick to one another and the valve opening narrows. The characteristic appearance specific to this picture is that on echocardiography the valve shows a narrowed opening resembling the shape of a “fish mouth”; this image is an important clue in our making the diagnosis.

The Frequency of Rheumatic Valve Disease in Turkey

A large-scale school screening carried out in Turkey showed that the frequency of subclinical (symptom-free) rheumatic heart disease in children is around 15 per thousand; this rate is consistent with similar screenings carried out in medium-to-high risk regions. These data show that rheumatic heart disease is still a health problem in our country that must be taken seriously.

Frequently Asked Questions

Does every throat infection lead to rheumatic fever? No; only inadequately treated infections with a particular type of streptococcus carry this risk, which is why it is important that throat infections be treated under a doctor’s supervision.

Can rheumatic valve disease be prevented? Yes; timely and complete treatment of streptococcal infections and, in people who have had rheumatic fever, regular antibiotic protection (secondary prophylaxis) are the most effective measures.

I had rheumatic fever in childhood, what should I do? We recommend that you be followed with regular echocardiography and that you comply with the preventive antibiotic programme your doctor recommends.

Conclusion

Rheumatic heart disease is preventable damage that a childhood infection leaves on the valves years later. Early diagnosis, regular follow-up and preventive treatment can largely halt the progression of the disease.

If you have a history of rheumatic fever in childhood or suspect valve disease, you can book an appointment for a detailed echocardiographic assessment.

References

1. Atalay S, Tutar E, Uçar T, Topçu S, Köse SK, Doğan MT. Echocardiographic Screening for Rheumatic Heart Disease in Turkish Schoolchildren. Cardiol Young. 2019;29(10):1272-1277.
2. Marijon E, Ou P, Celermajer DS, et al. Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening. N Engl J Med. 2007;357(5):470-476.