Rheumatic Heart Disease: Treatment, Cost and Side Effects

Rheumatic heart disease is a condition wherein due to autoimmunity against gram-positive bacteria called Streptococcus pyogenes that causes rheumatic fever and infection of the throat. If the fever or the infection goes untreated or is under-treated, it leads to rheumatic heart disease. The disease is characterised by repeated inflammation of the valves of the heart due to the bacterial infection. The inflammation or lesions on the valves are progressive and permanent. The valves on getting scarred gets narrowed down thereby causing leaking of blood when it flows from one heart chamber to the other through these valves. If kept untreated over the years it leads to heart failure. Rheumatic heart disease is caused due to rheumatic fever that occurs mostly in children aged between 5 and 15 years. The common symptoms of rheumatic heart disease are fever, painful, swollen, red and tender joints, nodules under the skin, discomfort in the chest and shortness of breath especially while lying down. It may be difficult to diagnose rheumatic heart disease. In spite of the infection, symptoms may be too mild that the patient may not want to visit the doctor. When the symptoms become severe, patients go for check-up. A throat culture or blood test is recommended for diagnosing a strep throat. A routine physical examination may reveal a heart murmur that is caused due to leaking of blood. The other tests recommended for diagnosing rheumatic heart disease are an echocardiogram (echo), electrocardiogram (ECG), cardiac MRI, chest X-ray and blood tests. Treatment involves using antibiotics initially to treat infection and aspirin to reduce inflammation. Steroids can also be given in case inflammation does not go away with aspirin. Thereafter, the patient must keep taking antibiotic as prescribed by the doctor to prevent any recurrence of the infection and related symptoms. If the valves do not repair even after extensive treatment and murmur of hear persists, surgery may be required to replace the valves.

The treatment for rheumatic heart disease mainly focuses on preventing rheumatic fever to recur. It is important to stop the rheumatic fever so that infection of the throat and inflammation of the joints and heart valves stop. Antibiotics like penicillin, erythromycin and sulphadiazine are used to treat the infection that causes strep throat and infection of the valves of the heart and also stops the rheumatic fever from recurring. If the fever has been for very long, then the patient will be prescribed with antibiotics to be taken daily so that rheumatic fever does not come back again, thereby reducing the risk of damage of the heart valves. Antibiotics have proved to work well and prevent infections. Inflammation of joints and heart muscles due to the infection can be treated with aspirins like ibuprofen, naproxen etc. Sometimes, if aspirins do not work, doctors can prescribe steroidal and anti-steroidal medications also. The damaged leaking valves normally do not require to be replaced until the condition becomes too severe and cannot be treated with antibiotics and aspirins. In such cases, surgery may be required to repair the valves either by opening up the thickened and stuck flaps, or by making the opening smaller by sewing the sutures around the ring of tissue that lies beneath the valves or by attaching a ring outside the valve to provide support to the valves or by simply replacing the valves with mechanical or biological valves.

People diagnosed with rheumatic heart fever due to the symptoms like tender and swollen joint pains, shortness of breath while lying down, chest pain, murmurs in heart due to leaking of blood.

Joint pains, tenderness and swollen joints, inflammation of joints, throat infection, shortness of breath etc. can be caused due to other reasons and infections also. So, if such patients do not get diagnosed for rheumatic fever and no murmur is heard on physical examination, they will not be eligible for rheumatic heart disease treatment.

Side effects of rheumatic heart disease treatment are mostly rare because the drugs are quite safe. Still sometimes and in some people there can be side effects like penicillin causing nausea, vomiting and stomach upset; long term use of aspirin can cause gastrointestinal ulcerations, heartburn, upset stomach, cramping, gastritis and bleeding and valve replacement in heart can cause some side effects like abnormality in heart rhythms, chest pain and fever, blood clots, breathing problem and infection.

Apart from taking medicines like antibiotics and aspirin for treating infection and inflammation, patients should keep their body hydrated by drinking lots of water, can also use some herbal teas to sooth throat infection. After surgery of heart for valve replacement, patients are recommended not to lift heavy objects, take ample amount of rest, do some walking in the morning and evening as a part of some light exercises.

It may take a few months to years to completely treat the infections that cause strep throat, infection and scarring of tissues of the heart valves. Antibiotics may be prescribed even for whole life to treat rheumatic fever and rheumatic heart disease. To recover from surgery it may take about 4 to 8 weeks to recover completely.

The cost of rheumatic heart disease treatment ranges from Rs. 500 to Rs. 4,00,000 including consultation, medication and surgery.

Yes, the results of the treatment are permanent once the infection has been completely eliminated from the body.

There is not much alternative treatment or any home remedy for treating rheumatic heart disease. Taking ample amount of rest for the inflammations and infection to reduce can help.