Updated 22 May 2015

Rheumatic heart disease

Rheumatic heart valve disease is the main cause of heart failure.


Every year many South African children and young adults are crippled or die as a result of rheumatic heart disease – and it all starts with an untreated sore throat.

Rheumatic heart valve disease is the main cause of heart failure among children and young people presenting in hospitals. It causes 400 000 deaths worldwide annually, mainly among children and young adults living in developing countries.

There are only three countries in the world – Egypt, Brazil and India– where more lives are claimed by rheumatic heart disease than in South Africa. In fact, rheumatic heart disease ranks as the number six cause of death due to heart disease in South Africa, claiming at least 1 642 lives every year. However, many cases are never diagnosed or reported.

“Because rheumatic heart disease affects mainly the poor, it is often neglected by researchers, health educators and the media. For example, no accurate, up-to-date statistics are available which can give us an indication of how prevalent the condition is in this country,” says Dr Bongani Mayosi, cardiologist at Groote Schuur Hospital.

Rheumatic fever is a serious immune disease which primarily affects children aged five to 15 years. The disease can cause inflammation and damage to several parts of the body, particularly the heart, joints and central nervous system.

The most common heart problem associated with rheumatic fever is heart valve damage. Between 40% and 60% of patients develop heart inflammation with their first attack of rheumatic fever, and this often results in permanent scarring of the heart valves, particularly the mitral valve. A scarred heart valve may prevent adequate blood flow or cause backward flow of blood. Damage to the heart valves may only show up 10 to 30 years after the initial infection.

Other heart problems which may develop are endocarditis (an inflammation of the lining of the heart), heart failure as a result of inflammation of the heart muscle, arrhythmias or abnormal heart rhythms, and pericarditis (an inflammation of the sac surrounding the heart).

Treatment of rheumatic heart disease is expensive and complicated. In advance stages it could involve the replacement of heart valves. But because one valve costs R50 000, state hospitals are forced to limit the number of heart valve replacement operations they would perform. As a result, many South Africans die while waiting for an operation. Even the lucky ones who do have surgery, may require further operations and are at risk for developing further heart problems.

These cases can be prevented easily and cheaply if antibiotics are administered to prevent its cause, rheumatic fever.

What causes rheumatic fever?
The exact cause of rheumatic fever is not yet known, but it occurs within one to five weeks after an infection with untreated group A streptococcus, the bacterium that causes "strep throat" and scarlet fever.

In some people, it appears that the body's immune system becomes overactive in its response to the streptococcus bacterium. This overreaction leads to inflammation and tissue damage in the heart and other parts of the body.

Spot the symptoms
“Our studies indicate that very few parents know that there is a connection between a sore throat and heart disease in children,” says Dr Bongani Mayosi, cardiologist at Groote Schuur Hospital.

Dr Mayosi advises all children with a sore throat, and who do not have a runny nose, to see a doctor as soon as possible.

Prompt and effective treatment of streptococcal infection with antibiotics will usually prevent rheumatic fever developing, and also reduces the risk of streptococcus being transmitted to other people.

People who have already had rheumatic fever are more susceptible to further attacks. Such people need long-term antibiotic treatment to prevent rheumatic heart disease.

Since there is no vaccine against Group A strep available or “anywhere near human study status”, according to Cape Town microbiologist Dr Andrew Whitelaw, early diagnosis and effective treatment are of the utmost importance.

If you suspect that someone has rheumatic fever, seek treatment immediately. Look out for the following symptoms:

  • Fever
  • Joint pain, which often moves from joint to joint
  • Joint swelling, which may be accompanied by redness and a sensation of heat
  • Abdominal pain
  • Vomiting
  • Skin rash: broad, pink to light-red patches that increase in size and do not itch
  • Small lumps under otherwise normal-looking skin
  • Unusual, involuntary jerky movements
  • Muscle pain
  • Confusion
  • Decreased muscle tone
  • Shakiness of one or more parts of the body
  • Speech difficulties
  • Coughing
  • Fatigue and weakness
  • Heart palpitations
  • Chest pain

These symptoms usually appear about two to four weeks after an untreated streptococcal infection. – (Ilse Pauw, Health24)


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