Fitness
That cough can affect your heart
Chronic throat infection can cause rheumatic fever, which can lead to rheumatic heart disease
Dr Deepak Khurana

Nearly 15 million people are currently affected by rheumatic heart disease

The heart is the most important organ of the body. It maintains the one-way traffic of the blood flow. The human heart comprises of four valves — aortic, mitral, tricuspid and pulmonary valves. It helps to maintain the uni-directional blood flow in the heart from lungs and its systemic circulation helps to supply oxygenated blood to the body.

Rheumatic fever can be a fatal result of chronic throat infection due to which inflammation occurs which can end up as Rheumatic Heart Disease, a major heart valve disorder.

Rheumatic Heart Disease (RHD) is the most commonly acquired heart disease in many developed countries but it majorly affects people in developing countries. Young children, mostly between the ages of 5-15 years, are affected by rheumatic fever which is caused by Group A streptococcal infection. Rheumatic fever can be controlled and prevented by treating streptococcal throat infection with antibiotics mainly the penicillin group or newer bactericidal agents. When we control the primary throat infection by antibiotics it’s called primary prevention. However in the secondary prevention, recurrences of rheumatic fever is controlled by using long-term penicillin antibiotics requiring once a month injection.

Young children, mostly between the ages of 5 and 15 years, are affected by rheumatic fever

Many times infection is either not diagnosed in time or left untreated for years. This can lead to fibrosis of heart valves leading to crippling valvular heart disease which can result in heart failure and eventually death. Some other causes for heart-valve disease may be congenital, blood infections, collagen tissue disorder, degenerative disease and many others.

Approximately 15 million people are estimated to be currently affected by RHD. A significant number of these people require constant medical care and repeated hospitalisation which can include expensive operative treatment and long-term medical care.

The global load of rheumatic fever usually falls on low socio-economic population with lesser awareness and access to medical facilities. The rural population is more exposed to the danger of this disease. Also, slums and clustered colonies in urban areas are affected.

Once the heart valves are affected these can contract (stenosis) or expand (regurgitation) either way which leads to variation in the forward flow of blood. Mitral and then aortic valves are most commonly affected by RHD. The symptoms usually consist of breathlessness or exertion, easy fatigability, tiredness, fainting attacks and palpitations. As the disease progresses it leads to swelling of feet, ankles, abdomen and then neck. Usually patient losses appetite and weight.

If valvular heart disease is detected during pregnancy then it needs prompt medical attention and careful medical and obstetric management, requiring tertiary care facilities and ability of the physician to handle possible complications.

There should be a preliminary examination by a physician who should be able to diagnose a heart-valve disease or murmur on auscultation. The patient has to under tests like the ECG, chest X ray and 2-D echo-cardiography, etc. Older patients may require a coronary angiography as well.

After the long-term medical care the patient may eventually require invasive treatment. In case of mitral stenosis, the valve can be opened by percutaneous route by using a balloon catheter procedure known as BMV (balloon mitral valvotony). But if the valve is calcified or heavily deceased than operative technique is necessary to repair or replace the valve. For that a ring or an artificial valve is required. The artificial valve can be metallic made up of silicon material or biological taken from animal heart. Metallic valve need lifelong care in the form of blood thinning drugs. Biological valves have a limited life-span after implantation.

The surgical technique usually requires opening the chest and using heart-lung machine to either repair or replace the diseased valve. Nowadays, minimal invasive operative techniques are being used in which a small cut is put in rib cage.

Newer techniques are coming up and being used to put valves in aortic or mitral position without undergoing a major surgery. However, these are expensive and not many are currently available to Indian masses. Nevertheless, timely treatment helps in preventing complications.

— The writer is director, cardiothoracic and vascular surgery, Rockland Hospital, New Delhi

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