Rheumatic fever is an inflammatory disease that presents after a throat infection caused by group A beta hemolytic streptococcus, and a late complication of this infection. It particularly involves the heart, joints, central nervous system, skin, and subcutaneous tissue. One or several of these organs, or sometimes all can be affected. If the heart is involved, resulting diseases are called Rheumatic Heart Disease.
Rheumatic fever often occurs between the age of 5 and 12 years old. The infection presents with sore throat, quinsy, fever, ear ache, and asthenia and can lead to a heart disease as a complication of rheumatic fever in 1-4 weeks if poorly treated. Rheumatic heart disease is the primary disease in heart diseases in school age children and the prevalence is 1-2%. The most affected part is the mitral valve; it narrows, stiffens, and shrinks. Mitral stenosis and failure, mostly in women, develop. The second most affected valve is aortic valve. Tricuspid and pulmonary valve become affected less. Sometimes, several valves can become ill together.
Mitral Valve is located between the left atrium and ventricle of the heart and has 2 leaflets, which prevents blood from flowing back. Mitral Valve normally covers an area of 4-6 cm². The symptoms present when it is less than 2,5 cm². There are structures called chorda that provides movement of the valve, and the annulus surrounding the valve. Damage to these structures can cause stenosis and regurgitation. In this case, the symptoms e.g. dyspnea, heart-throb, and tiredness, which initially present with effort, are seen even when resting as the disease progresses. Haemoptysis may occur.
Clot may be formed in mitral stenosis because blood flow decelerates in the left atrium, and this clot can obstruct the vessels of organs, e.g. arms, legs, and brain, etc, through circulation (thromboembolism) and may lead to severe life-threatening states. In addition, and rhythm disturbances and most commonly atrial fibrillation may occur due to enlarged left atrium. The blood pressure increases due to volume of blood in the left cardiac cavity in mitral stenosis and regurgitation. This cavity starts expanding. In an advanced stage, the power of the heart to contract becomes impaired and intrapulmonic pressure increases backward, and dyspnea and heart failure occur.
The valve between the left ventricle and aorta, the largest vessel supplying the body, is the aortic valve. It has 3 leaflets. It may sometimes include 2 leaflets congenitally. Aortic valve normally covers an area of 3-4 cm². Aortic stenosis does not present symptoms for long term. The initial sign is quick tiredness with effort. The symptoms present when the area of valve is less than 1,5 cm². Chest pain, dizziness, and syncope occur in progressed aortic stenosis. The patient might die in 1 year if they do not receive treatment immediately after this stage.
It is a state that aortic valve is unable to close sufficiently and the blood flows back. Some part of the blood pumped by the left ventricle to the aorta returns to the left ventricle when the heart relaxes. Work load of the left ventricle increases, which consistently pumps the blood forward together with the blood flowing back. The left heart dilates. Heart failure occurs. The diastole dropped with blood flowing back adversely affect circulation of cardiac vessels (coronary vessels), resulting in chest pain. Dyspnea, heart-throb, getting tired quickly, and chest pain are the most common symptoms with effort. Syncope is rare.
Tricuspid valve is located between the right atrium and ventricle. It usually develops secondary with other valvular problems. Tricuspid valve disease alone is rare. It progresses with the symptoms of the right heart failure, such as jugular venous distension, and swelling of abdomen and legs.
It is located between the right ventricle and the pulmonary artery. Prevents the blood from the right ventricle to the lungs to return. It has 3 leaflets. Rheumatic pulmonary artery stenosis is very rare. It is often congenital. The mild form does not present any symptoms. Tiredness and the dyspnea with effort occur if moderate and severe stenosis are present. Rheumatic pulmonary valve regurgitation is also very rare. The blood flows back to the right ventricle from pulmonary vessel. Again, general symptoms are present, e.g. getting tired quickly and dyspnea. The symptoms of right heart failure occur in an advanced stage. Swelling of feet, liver dilatation, and jugular venous distension may occur.