Rheumatic heart disease is a condition of the heart caused by damage from rheumatic fever. A strep throat infection can progress to rheumatic fever. Rheumatic fever affects many of the body's connective tissues, especially in the heart, brain, joints or skin. Although anyone can get rheumatic fever, it more often affects children 5 to 15. The resulting heart valve damage can last a lifetime.
Rest
Although the best treatment is prevention, rheumatic heart disease continues to develop in a small number of patients who are not responsive to the initial rounds of antibiotics, or who do not receive antibiotics for the strep throat. Physicians at the University of Virginia Health System recommend that if inflammation does develop, bed rest may be recommended to decrease the workload on the heart muscle and valves.
Immediate Medications
Along with the prescribed rest, physicians administer medications to decrease the inflammation in the heart muscle and other connective tissues. Physicians at the University of Virginia Health Systems also recommend the administration of antibiotics to treat the Streptococcus bacteria. According to the physicians at the University of California San Francisco Children's Hospital, children diagnosed with acute rheumatic fever should remain on antibiotics, such as penicillin, for many years to prevent the recurrence of Streptococcus infection and further heart damage. They may also be placed on large doses of aspirin to help decrease the inflammation in the body. Most often a valve leak caused by the disease is mild and does not need treatment, but if the leak in the heart valve is sufficient to cause additional strain on the heart, medications to support the heart should be considered.
Chronic Medications
As the workload on the heart increases with age, vasodilator drug therapy may be suggested to decrease the strain on the volume-overloaded ventricles. According to authors Warren Walsh and Alex Brown in their review, "The Diagnosis and Management of Chronic Rheumatic Heart Disease," this treatment is reserved for those with aortic valve damage. Those who suffer from mitral valve damage benefit only if there is associated heart failure. Those who have aortic regurgitation also benefit from diuretics and ACE inhibitors to support cardiac function.
Surgical Interventions
Authors Warren Walsh and Alex Brown from the Department of Cardiovascular Medicine at the Prince of Wales Hospital in Australia advocate the use of valve repair over valve replacement when there is mitral valve damage. Mitral valve repair has a lower risk in the operating room and preserves heart function better than a replacement of the valve. A repair of the valve does not require follow-up anti-coagulant therapy and has a higher rate of 10 year survival. Patients with aortic regurgitation, who have symptoms, should be referred for surgery. The aortic valve is a higher flow and pressure area than the mitral valve. This means that either repair or replacement is subject to deterioration within 10 to 15 years. Homograft is tissue taken from a donor and used to replace the damaged valve. These have the same hemodynamics as a native aortic valve, but there is a limited supply and they can be associated with calcification as they deteriorate after placement.
