Symptoms and Treatment Methods of Rheumatic Heart Disease (Acute Rheumatic Fever)

Acute rheumatic fever, commonly known as rheumatic heart disease, is a rheumatic condition that develops after a throat infection (pharyngitis) caused by bacteria known as group A streptococci. It typically appears 2 to 3 weeks after the pharyngitis. The disease results in inflammatory damage in organs containing connective tissue due to an abnormal inflammatory response from the body.

Acute rheumatic fever is more commonly seen in children. Although it primarily affects the joints, it is significant because it can also involve the heart. Symptoms in the disease may include inflammation in the blood vessels of the brain and swelling of subcutaneous lymph nodes. Rheumatic heart disease most often affects children between the ages of 5 and 15, as pharyngitis caused by group A beta-hemolytic streptococcus is most prevalent in this age group. However, it can occur at any age. The disease is the most common cause of acquired heart disease in children worldwide.

Symptoms and Signs of Rheumatic Heart Disease

This disease affects the entire body, presenting a wide range of symptoms and signs. The symptoms of rheumatic heart disease include:

• Joint inflammation and pain
• Inflammation of the heart membranes
• Damage to heart valves, leading to a heart murmur
• Chest pain
• Fatigue
• Chorea: A condition caused by inflammation in the brain. Patients with chorea exhibit involuntary, purposeless movements, often more frequent in the trunk and arms. It may also be accompanied by muscle weakness and emotional instability. Chorea is not permanent and disappears during sleep, usually improving within 1-2 weeks. In rare cases, symptoms may last up to 15 weeks.
• Emotional instability: Emotional disturbances may appear as inappropriate laughing or crying.
• Fever ranging from 38-40°C
• Nosebleeds
• Abdominal pain
• Enlargement of the spleen
• Painless nodules under the skin, especially on the back of the arms and the front of the legs
• Rashes on the inner surfaces of the chest, arms, and legs
• Elevated CRP, sedimentation, and leukocyte blood levels
• Heart enlargement visible on a chest X-ray

Causes of Acute Rheumatic Fever

A rheumatic attack can develop after a throat infection caused by a bacterium called group A beta-hemolytic streptococcus. Group A streptococci can cause cryptic throat infections or, less commonly, scarlet fever. Infections of the skin or other areas of the body by group A streptococci rarely trigger rheumatic fever.

The link between streptococcal infections and rheumatic fever is not entirely clear, but the bacteria seem to cause confusion in the immune system. The streptococcal bacteria contain a protein similar to one found in certain body tissues. Immune cells that typically target the bacteria begin to mistakenly attack the body’s own tissues as though they were infectious agents, particularly targeting the heart, joints, skin, and central nervous system. This immune response results in inflammation in these organs.

If your child is treated promptly with antibiotics to eliminate streptococcal bacteria and takes all prescribed medication as directed, the risk of developing rheumatic fever becomes very low. However, if your child has had one or more untreated streptococcal throat infections or scarlet fever episodes, they may be at risk for rheumatic fever.

Treatment of Rheumatic Heart Disease

The goal of treating rheumatic heart disease is to eliminate any remaining group A streptococcal bacteria, relieve symptoms, control inflammation, and prevent recurrence of the disease. Treatment includes antibiotics, anti-inflammatory medications, and drugs for managing neurological symptoms