Rheumatic heart disease is the most serious complication of rheumatic fever. As many as 39% of patients with acute rheumatic fever may develop varying degrees of pancarditis with associated valve insufficiency, heart failure, pericarditis, and even death. With chronic rheumatic heart disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic rheumatic heart disease remains the leading cause of mitral valve stenosis and valve replacement in adults in the United States.
Acute rheumatic fever and rheumatic heart disease are thought to result from an autoimmune response, but the exact pathogenesis remains unclear. While rheumatic heart disease was the leading cause of death 100 years ago in people aged 5-20 years in the United States, incidence of this disease has decreased in developed countries, and the mortality rate has dropped to just above 0% since the 1960s. Worldwide, rheumatic heart disease remains a major health problem. Chronic rheumatic heart disease is estimated to exist in 5-30 million children and young adults; 90,000 patients die from this disease each year. The mortality rate from this disease remains 1-10%.
Conditions that suggest Rheumatic Heart Disease
Heart Valve Stenosis
ThemMitral valve is most often affected with rheumatic heart disease, followed by mitral and aortic together, then aortic alone, then mitral, aortic, and tricuspid together.
Risk factors for Rheumatic Heart Disease
Rheumatic Fever
After the acute attack of rheumatic fever has subsided, many people are left with damaged heart valves (rheumatic heart disease). Some people will have recurrent acute attacks of rheumatic fever, frequently causing more damage to the heart valves.
Recommendations for Rheumatic Heart Disease
Antibiotics
Those people who have already suffered a rheumatic fever attack are extremely susceptible to a recurrence if they are again infected with group A streptococci. Patients who have experienced a documented acute rheumatic fever attack should receive continuous antibiotic prophylaxis to prevent streptococcal infections at least until reaching adulthood or at least 5 years after their most recent attack. Patients whose acute rheumatic fever attack has left them with damaged heart tissue may need lifelong antibiotic prophylaxis. Invasive dental or surgical procedures may require additional antibiotic prophylaxis for patients with rheumatic valvular heart disease.
Vitamin E
Do not start with high doses of vitamin E in chronic rheumatic heart disease.
Key
 | Strong or generally accepted link |
 | Proven definite or direct link |
 | Likely to help |
 | Avoid absolutely |
Glossary
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Stenosis
(Esophageal, GI tract): Narrowing.
Arrhythmia
A condition caused by variation in the regular rhythm of the heartbeat. Arrhythmias may cause serious conditions such as shock and congestive heart failure, or even death.
Autoimmune Disease
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
