Pathology:
“Rheumatic fever licks the joints, but bites the heart” is an oft used proverb to explain the onset of Rheumatic Heart Disease.
The patient has usually suffered a bout of Rheumatic Fever in his childhood. The common symptoms of Rheumatic Fever are Fever, Sore Throat and Joint Pain. After a long latent period of 10 to 40 years since the first episode of Rheumatic Fever, symptoms related to valvular heart disease occur.
In many cases, the patient suffering from Rheumatic Heart Disease may not be aware of having contracted Rheumatic Fever during his childhood.
Complications:
In Rheumatic Heart Disease, both the Aortic & Mitral Valves malfunction either blocking blood from flowing across the valves (Aortic or Mitral Stenosis) or letting it flow back across the valve (Aortic or Mitral Regurgitation).
- Stenosis: In certain diseases, leaflets of Aortic and/or Mitral Valve thicken and fuse leading to reduced mobility and narrowing of the opening, reducing flow of blood from heart to body.
- Aortic Stenosis: The arteries supplying blood to the heart (Coronary Arteries) connect to the Aorta immediately after the Aortic Valve. A reduced flow of blood through these Coronary Arteries can cause chest pain (Angina on Exertion). The ascending Aorta further connects to three arteries which supply blood to both the hands and the brain. Reduction of blood flowing into the brain causes fainting or passing out (Syncope). Increase in back-pressure due to obstruction to flow of blood in the heart and lungs causes Breathlessness.
- Mitral Stenosis: A reduced flow of Blood from Left Atrium to Left Ventricle leads to increased pressure in Left Atrium and causes back pressure to build up in Lungs. Increase in back-pressure due to obstruction to flow of blood in heart and lungs causes Breathlessness. Due to obstruction to flow of blood through Mitral Valve, volume of blood in Left Atrium increases causing it to enlarge. As the enlargement becomes significant, Left Atrium is Unable to contract. This upsets Electrical Rhythm (Atrial Fibrillation) of the heart causing Palpitation. Stagnation of blood in Left Atrium, may lead to a possibility of Blood Clots, which if ejected into the blood stream can cause Stroke.
- Regurgitation: In certain diseases, leaflets of Aortic and/or Mitral Valve do not close completely. This results in blood flowing back into the previous chamber. Atrium or Left Ventricle leading to increased back-pressure in the heart and lungs causing Palpitation and Breathlessness.
- Aortic Regurgitation: As the disease progresses or due to infection of the leaflets, the Aortic valve may lose their ability to close completely. This results in blood flowing back into the heart from the Aorta leading to increased back-pressure in the heart and lungs causing Palpitation and Breathlessness.
- Mitral Regurgitation: As the disease progresses or due to infection of the leaflets, Mitral Valve lose its ability to close completely. This results in blood flowing back into the Left Atrium leading to increased back-pressure in the heart and lungs causing Palpitation and Breathlessness.
Treatment:
The usual investigations needed to diagnose and plan treatment for Rheumatic Heart Disease is 2D Echo and occasionally, Transesophageal Echocardiography (TEE). In patients above 40 years of age, Coronary Angiography is required before surgery to identify Coronary Artery Blockages.
Depending on the condition of the Valves, procedures required to treat Rheumatic Valvular Heart Disease are one or combination of following surgeries.
- Aortic Valve Replacement (AVR) Surgery
- Mitral Valve Replacement (MVR) Surgery
- Double Valve Replacement (DVR) Surgery
- Tricuspid Valve Repair (TV Repair/TVA) Surgery
(Follow links to know more about the procedure)
