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What is it?

Rheumatic fever is a condition that follows infection with a bug called streptococcus. This often causes sore throat in the preceding weeks, and only in some individuals is followed by rheumatic fever. Rheumatic fever affects the heart in addition to joints, skin and brain. There are certain criteria to be fulfilled for diagnosis of rheumatic fever. Diagnosis is made by a combination of tests of which, a review by a paediatric cardiologist is crucial.


How common is it?


Rheumatic fever and heart disease is a rare occurrence in the Western world and is often missed or treated wrongly. Dr Khambadkone has a large experience of diagnosing and treating rheumatic fever and heart disease following on from his overseas training and clinical experience.


What are the symptoms of Rheumatic fever?


The most frequent symptom is joint pain affecting multiple joints after sore throat. Associated symptoms may be red swollen and painful large joints such as knees, elbows and wrists. Skin rashes or small swellings (nodules) may go unnoticed. Rheumatic chorea is abnormal movements of the arms and legs, associated with change in emotional state. Fever is usually seen in early part of the illness. Acute rheumatic fever involves the heart valves, heart muscle and the covering of the heart called pericardium. Symptoms suggestive of heart involvement are breathlessness, palpitations, swelling of feet or on face. Acute rheumatic fever should be diagnosed early and treated appropriately to prevent rheumatic heart disease.


How does Rheumatic fever affect the heart?


Rheumatic heart disease is late manifestations from residual scarring from rheumatic fever and affects heart valves. The scarring causes the valve tissue to shrivel and shorten and results in leaking of blood back into the chambers. Over a period of time, this results in heart failure and can only be treated by surgery. Valves affected by rheumatic disease are more susceptible to infection, called “endocarditis”. Infection of heart valves are difficult to treat and require antibiotics given through the veins for many weeks and may require surgery.


How is it treated?

Acute rheumatic fever is treated with antibiotics and anti-imflammatory medications. If started early, the scarring of valves is limited with good long term outcome provided recurrence of rheumatic fever is avoided by taking preventative antibiotics. Rheumatic valve disease is treated with medications to control the effects of valve disease. When these measures fail, repair or replacement of heart valves by surgery is the only option. Valves are replaced with tissue valves or mechanical or artificial valves. Prevention of rheumatic fever involves early detection and treatment of streptococcal sore throat.

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