Rheumatic heart disease in children

Rheumatic heart disease (RHD) is a serious cardiovascular condition that can affect children and adults. It is a consequence of untreated or inadequately treated streptococcal throat infections, particularly in populations with limited access to healthcare. RHD is most common in children and young adults and can lead to significant heart valve damage. Here are key points about rheumatic heart disease in children:

Cause:
- RHD is caused by an autoimmune response to a bacterial infection, specifically group A Streptococcus (Streptococcus pyogenes). The initial infection, known as strep throat or pharyngitis, can trigger an immune response that damages the heart valves.
Development:
- RHD does not develop immediately after a streptococcal infection. It typically takes weeks to months for symptoms to appear and heart valve damage to occur.
- Repeated episodes of untreated streptococcal infections increase the risk of RHD.
Symptoms:
- In children, the symptoms of RHD can vary and may include fatigue, shortness of breath, chest pain, joint pain, and swelling of the ankles, feet, or abdomen.
- As RHD progresses, it can lead to heart murmurs, which can be detected during a physical examination.
Complications:
- The most significant complications of RHD involve damage to the heart valves, especially the mitral and aortic valves. This damage can result in valve stenosis (narrowing) or regurgitation (leakage), which can impair the heart’s ability to pump blood effectively.
- Over time, RHD can lead to heart failure, arrhythmias, and other cardiovascular problems.
Diagnosis:
- The diagnosis of RHD involves a combination of medical history, physical examination, echocardiography (ultrasound of the heart), and sometimes other cardiac imaging studies.
- Echocardiography is essential for assessing the extent of heart valve damage and monitoring disease progression.
Treatment:
- Treatment for RHD typically involves managing symptoms, preventing further streptococcal infections with antibiotics (such as penicillin), and addressing complications.
- Children with severe heart valve damage may require surgical intervention to repair or replace damaged valves.
Prevention:
- The best way to prevent RHD in children is to promptly and effectively treat streptococcal throat infections with antibiotics.
- In some regions with a high prevalence of RHD, secondary prophylaxis (long-term antibiotic treatment) may be recommended to prevent recurrent streptococcal infections.
Prognosis:
- The prognosis for children with RHD depends on the severity of valve damage, the effectiveness of treatment, and access to healthcare.
- With proper medical care, including antibiotics and, when necessary, surgical interventions, many children with RHD can lead relatively normal lives. However, lifelong follow-up and care are often required.

Rheumatic heart disease remains a significant public health concern in certain parts of the world, particularly in low-resource settings where access to healthcare and antibiotics may be limited. Prevention through early diagnosis and treatment of streptococcal infections is crucial to reducing the incidence of RHD in children.