Discussion Author(s): Primary author: Jason Messinger
Contributing author: Eric Jones
Rheumatic valve disease is an inflammatory condition that presents as damaged heart valves from rheumatic fever and is the leading cause of death in patients with rheumatic fever. Rheumatic fever afflicts patients that have had Strep pharyngitis (strep throat) caused by a Group A Streptococcus infection and can be a lifelong condition. The physiology behind rheumatic valve disease is that antibodies that the hostâ€™s immune system forms against the Strep infection cross react with the host's own tissues, notably those of the heart valve. Antibodies interact with the heart valve and cause a sustained and potentially life threatening inflammation of the valves which can lead to regurgitation, stenosis, thromboembolism, and other cardiovascular sequelae. Imaging for rheumatic valve disease includes echocardiography and CT.
The prevalence of rheumatic fever has remained relatively unchanged internationally yet has dropped significantly in the US. Developing rheumatic fever depends on infection by Group A Strep, which is prevalent among patients between the ages of 5 and 15. Without adequate treatment with penicillin or other antibiotics rheumatic fever may develop. Symptoms of the disease may not manifest until much later in life, but on average, it is about 3 weeks post Group A Strep infection. Symptoms of rheumatic fever include sudden fever onset, shortness of breath, inflamed and painful joints where pain may migrate from one joint to another, fatigue, chest pain, and skin rashes.
The mitral valve is the most often and severely affected followed by the aortic and tricuspid valve. Treatment for rheumatic valve disease ranges from antibiotics (with a 60-80% reported success) to surgical intervention in which the affected valve(s) is repaired or replaced. Rheumatic fever can be prevented by treating Group A Strep infections aggressively. Once a patient develops rheumatic valve disease the chance of recurrence is greatly increased.
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