Rheumatic heart disease is the leading cause of death from rheumatic fever with about 233,000 deaths each year. There are approximately 15.6 million people world wide who suffer from rheumatic heart disease with about 282,000 new cases annually. Because of these numbers, it is important to understand the pathophysiology of rheumatic heart disease so that patients can be diagnosed and treated.
Rheumatic fever occurs as the result of an untreated strep infection. Normally the antibodies in the body will attack the streptococcal bacteria, but sometimes the antibodies end up attacking the heart or joint tissues instead. Rheumatic heart disease is the most serious complication of rheumatic fever and refers to the manifestations of rheumatic fever in the cardiovascular system. Rheumatic heart disease involves damage to the entire heart and its membranes. The pathophysiology of rheumatic heart disease explains how the heart and other organs of the body are affected.
Mitral stenosis is the most common pathophysiological effect of rheumatic fever, and rheumatic fever is the most common cause of mitral valve stenosis. When the antibodies attack the heart, they cause swelling in the heart valves. The swelling causes narrowing and allows less blood to flow from the left atrium to the left ventricle. With more blood left in the left atrium, it has increased pressure and swells. Mitral stenosis can result in shortness of breath, angina-like pain, fatigue, and coughing up blood.
Pancarditis is the second most common complication of rheumatic heart disease, but is the most serious. It can cause shortness of breath, pleuritic chest pain, moderate chest discomfort, swelling, cough, or orthopnea. Pancarditis caused by rheumatic heart disease is characterized by myocarditis, endocarditis and pericarditis.
Myocarditis causes lesions called Aschoff bodies and causes inflammation of the heart muscle (myocardium). It can cause rapid heart beat, shortness of breath, irregular heart rhythm, or pulmonary edema.
Endocarditis is the inflammation of the lining of the heart chambers and the valves. It usually affects the mitral valve in women and the aortic valve in men. Rarely is the tricuspid or the pulmonary valve affected. Endocarditis can cause fever, chills, shortness of breath, persistent cough, blood in urine, weight loss, night sweats, and aching joints.
Pericarditis is inflammation of the pericardium, the sac-like covering around the heart. It can cause friction and pain in the chest. Other symptoms include dry cough, low grade fever, weakness and fatigue, and abdominal or leg swelling.
Congestive Heart Failure
Congestive heart failure is when the heart doesn’t pump strongly enough, resulting in a buildup of fluid called congestion in the lungs or other body tissues. With rheumatic heart disease, it is generally a secondary symptom of the pancarditis or myocarditis.
Atrial fibrillation is a fast, irregular contracting of the atria. It causes the atria to be unable to properly pump blood in the ventricles. This condition can be a result of rheumatic heart disease.