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Rheumatic heart disease: Focus on prevention

» How it happens

» Assessing the damage

» Defensive strategy

Protecting yourself against endocarditis

Anyone with damaged or artificial heart valves could be susceptible to bacterial endocarditis, a potentially fatal heart infection. In the past, many people were advised to use preventive antibiotics before dental procedures and oral, respiratory-tract, urologic or gastrointestinal surgeries because they might introduce bacteria into the body. But new guidelines from the American Heart Association suggest only those at highest risk of complications from endocarditis use preventive antibiotics. These include people with artificial valves, a history of endocarditis, certain congenital (present from birth) heart conditions or a heart transplant with a valve problem. To play it safe, make sure all of your healthcare providers know if you’ve had rheumatic fever or any problem with your heart valves.

A simple sore throat can lead to a lifetime of heart trouble. At least, that’s the case with rheumatic heart disease, the end point of a cycle that usually begins with an untreated case of strep throat in childhood.

How it happens

In most cases, ignoring strep throat (the signs: a sudden sore throat, fever, painful swallowing and swollen glands) won’t lead to dire consequences. But sometimes lingering streptococcal bacteria cause rheumatic fever, an inflammatory disease that can surface up to four weeks after the throat has healed.

And when the fever hits—it usually strikes children between 5 and 15—it’s with a vengeance: high temperature, chills, joint aches and a rash all are hallmarks. The inflammation can spread to the brain or the heart, where it attacks the valves. As a result, the valves may not open or close properly, leading to further damage. Permanent heart damage caused by rheumatic fever is called rheumatic heart disease.

Assessing the damage

Because valve damage can progress slowly and steadily, eventually harming the heart muscle itself, it’s important to see your doctor regularly if you’ve had rheumatic fever. He or she can keep an eye on your valves and determine if valve replacement surgery is needed.

Defensive strategy

If you’ve had rheumatic fever, you can get it again. For that reason, and to prevent further damage, people who have had rheumatic fever are given monthly or weekly antibiotic treatment.

Of course, the best defense of all is avoiding rheumatic fever in the first place by recognizing the signs of strep throat—particularly in children—and treating it with antibiotics.

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