Rheumatic Heart Disease (RHD) is a commonly acquired heart problem that emerges either through one severe episode or several episodes of chronic rheumatic fever.
The symptoms of RHD include heart, nervous system, skin, and joint inflammation, chest pain, and breathe shortness (Carapetis et al., 2016). The heart inflammation affects the internal heart linings and the valves. The inflammation causes the valve leaflets to swell, erode, and develop lesions and scars. RHD can affect all valves including pulmonic, tricuspid, aortic, and mitral even though the disease predominantly affects the mitral valve. A majority of RHD patients fail to identify its symptoms until heart failure symptoms emerge. With time and as the heart attempts to force blood through the affected valve, the heart muscle thickens and dilate and eventually becomes dysfunctional. Patients with heart failure symptoms mainly experience breath shortness and inability to engage in physical activity.
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Recurrent rheumatic fever episodes affect older children and may continue into young adulthood. Since it takes several rheumatic episodes to cause RHD, RHD mainly affects young people in their twenties and thirties, even though the disease also affects children and teenagers significantly (Carapetis et al., 2016). RHD is a progressive and chronic illness that can be prevented using antibiotics. The disease starts with an infection of the pharyngeal group A streptococcus or strep throat, which may cause rheumatic fever in some people (Zühlke et al., 2017). While the body activates its antigens to fight the infection, these antigens end up attacking both the infection and the body tissues since the bacteria have a similar protein to that of the normal tissues of the body.
How Rheumatic Heart Disease changes the Normal Healthy System
The Anatomy of the Cardiovascular System
The heart consists of four chambers including the upper atrium chamber consisting of the right atrium and the left atrium and the ventricle chamber comprising of the right ventricle and the left ventricle. The atrioventricular valves seal these chambers, the mitral valve guards the opening between the left atrium and left ventricle while the aortic valve guards the opening of the aorta (Betts et al., 2016). These valves are normally elastic and soft and open and close in a single direction only to ensure that blood does not flow backwards.
The physiology of the Cardiovascular System
The atrium receives blood from the body and pumps it into the ventricle, which then pumps blood to the entire body. The valves work by opening to allow the flow of blood and closing to hinder blood backflow (Betts et al., 2016). For instance, the aortic valve at the base of the aorta hinders the backflow of blood from the aorta. Additionally, the opening of the mitral valve allows the movement of blood from the left atrium into the left ventricle. Closing of the mitral valve hinders the backflow of blood into the left atrium.
The Importance of the Cardiovascular System to the Overall Body Homeostasis
The heart or the cardiovascular system comprises a closed system of blood vessels and the heart. The heart focuses on pumping blood through a system of blood vessels and these vessels enable the blood to circulate across the entire body. The significance of the heart is obvious given that the heartbeats 100,000 times per day to push 5,000 gallons of blood across the entire body each day to deliver nutrients and oxygen to various body tissues besides carrying away carbon dioxide and waste products from the tissues (Betts et al., 2016).
The Effect of RHD on the Cardiovascular System
Anatomy and physiology changes
The disease causes the mitral valve to become stiff, which prevents it from opening and closing throughout. In turn, this impedes the flow of blood from the left atrium into the left ventricle. Another effect is mitral regurgitation that causes the blood to be forced back into the left atrium rather than flow out through the aortic valve to supply the whole body. Mitral regurgitation leads to the development of a systolic murmur across the chest wall.
Mitral regurgitation affects mainly young adults and children and emerges as pure mitral regurgitation (Zühlke et al., 2017). Mitral regurgitation emerges due to the morphological changes caused by chronic mitral valve apparatus and mitral valve scarring (Carapetis et al., 2016). The changes include valvular thickening, chordal thickening, and mitral valve prolapse (Carapetis et al., 2016). Mitral stenosis can also emerge later if the valvular scarring continues and can be similar to mitral regurgitation morphologically (Carapetis et al., 2016). RHD causes the shortening and fusion of the mitral valve chords and commissural fusion, which restricts the movement of mitral valve leaflets (Zühlke et al., 2017). Severe mitral stenosis results in high pulmonary venous pressure, which may lead to pulmonary hypertension. Aortic regurgitation, aortic stenosis, and mixed valve illness can also emerge. Aortic regurgitation occurs due to the thickening of the aortic valve that is usually nodular and irregular and leads to increased pressure on the left ventricle and ventricular dilation (Carapetis, 2016). Aortic stenosis is less common but occurs due to progressive aortic valve thickening and may lead to poor cardiac output and left heart failure (Carapetis, 2016) mixed valve illness involving the occurrence of both mitral stenosis and mitral regurgitation occurs in chronic RHD (Carapetis, 2016).
The Risk Factors of RHD
There are several risk factors of RHD including age, gender and environmental factors such as undernutrition, lack of health care access, poor hygiene, and crowding (Carapetis, 2016) RHD significantly affects the youth when it comes to age. Regarding gender, RHD affects females more than males (Carapetis, 2016). According to studies Carapetis (2016), this may be due to increased vulnerability of autoimmune reactions following bacterial infection among women or social factors such as child-raising involvement that increases the possibility and vulnerability of pathogenic infections combined with low access to main and secondary prevention strategies. Additionally, RHD emerges during pregnancy due to the increased cardiac burden concerning the disease (Carapetis, 2016)
Environmental risk factors increase the vulnerability of being exposed to the S, pyogenes infections. For instance, crowding in households increases the probability of suffering from rheumatic fever (Zühlke et al., 2017). Studies have also found the prevalence of RHD to be high in remote and rural locations and urban slums, which further reflects risk factors such as crowding caused by reduced socioeconomic status or low access to health care (Carapetis, 2016). Inadequate nutrition among children also increases the vulnerability to RHD, even though this connection is unclear (Zühlke et al., 2017).
The Impact on society of RHD
The social and economic impact
The socio-economic effect of RHD is both directly and indirectly to the society, family, and patient (Zühlke et al., 2017). Direct costs among families include lost wages, transportation, laboratory tests, and medical consultations. To the society, direct costs include laboratory test, medications, surgical expenses and cardiac catheterization, hospital admissions, and medical consultations unpaid for by families. The assumption here is that a majority of patients receive public health insurance. Families also incur indirect costs through wages lost due to missed work while the society incurs indirect costs concerning lost workdays.
Epidemics
The burden of RHD globally is substantial and is mainly prevalent in groups residing in insufficient resource environments (Zühlke et al., 2017). The number of new RHD cases is estimated to be about 300,000 each year with over 200,000 deaths within the same period (Zühlke et al., 2017). The estimated global burden of RHD demonstrates that over 34 million people suffer from the disease, which leads to a loss of nearly 10 million life-years (Carapetis, 2016)
Prevalence of RHD
RHD mainly affects resource deprived environments, particularly in underdeveloped and emerging countries of the world and among the indigenous groups in developed countries because these locations lack well-established health care systems (Zühlke et al., 2017). In these environments, the illness causes most of the heart mortality and morbidity among the youth and lead to nearly 250,000 deaths every year across the world.
Treatment
Treatment of RHD depends on its severity. Oral antibiotics including the use of penicillin are used for primary prevention to hinder the initial infection from causing rheumatic fever (Zühlke et al., 2017). The patient is placed under the antibiotics for 10 days or once through intramuscular injection.
Treating the already present rheumatic fever involves focusing on preventing secondary infections from causing extra damage to the heart. Here, patients are placed under prophylactic antibiotic drugs regularly over an extended period.
The affected areas may also be surgically repaired or replaced if the RHD progression is severe (Carapetis, 2016).
While penicillin can be used effectively to prevent RHD, advanced stages of the disease consume significant resources, which make it challenging to manage it, particularly in under-resourced locations such as the emerging countries (Carapetis, 2016). Emphasis is now on using prophylaxis to deal with recurrent acute rheumatic fever episodes as a cost-effective and feasible approach.
The disease can lead to irreversible damage to the involved valves and heart failure (Carapetis, 2016).
Areas of Research Required
There is still a need to investigate the techniques that can be used for determining the efficacy of early detection of RHD through echocardiographic screening because most people fail to determine that they have the disease until it is too let. Even though treatments are available, identifying the disease early may reduce the burden of treatment costs given that RHD mostly affects resource-deprived locations that comprise of people with insufficient income. Additionally, it is important to continue researching novel diagnostic techniques for group A Streptococcus and the chronic rheumatic fever to inform future RHD prevention approaches.
Funding
Congress should put $10,000 toward RHD research because while more researchers have investigated RHD and offered important data to guide the development of programs to deal with the disease, the current research has not been implemented into different care models in resource-deprived environments to offer a strong evidence base for RHD practice and policy. Congress should put money toward researching RHD because while the disease is preventable, it is negatively affecting people of low socioeconomic status significantly. Committing $10,000 will help address the increasing cardiovascular inequality for underprivileged members of the society to close the health care gap. The disease also subjects young people to costly and painful treatment such as open-heart surgery besides causing fatalities among the youth. The money will be used to research local community-based intervention measures to hinder and eliminate the disease.
References
Betts, J. G., Desaix, P., Johnson, E., Johnson, J. E., Korol, O., Kruse, D., Poe, B., Wise, J., Womble, M. D., Young, K. A., & College, O. (2016). Anatomy & physiology. Openstax College, Rice University.
Carapetis, J. R., Beaton, A., Cunningham, M. W., Guilherme, L., Karthikeyan, G., Mayosi, B. M., ... & Zühlke, L. (2016). Acute rheumatic fever and rheumatic heart disease. Nature reviews Disease primers , 2 (1), 1-24. https://doi.org/10.1038/nrdp.2015.85 .
Zühlke, L. J., Beaton, A., Engel, M. E., Hugo-Hamman, C. T., Karthikeyan, G., Katzenellenbogen, J. M., Ntusi, N., Ralph, A. P., Saxena, A., Smeesters, P. R., Watkins, D., Zilla, P., & Carapetis, J. (2017). Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations. Current Treatment Options in Cardiovascular Medicine , 19 (2). https://doi.org/10.1007/s11936-017-0513-y
