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Heart failure

The major cause of death and disability from RHD is heart failure.  Over time, scarred and damaged heart valves make it impossible for the heart to pump blood effectively. Without a well-functioning heart, fluid builds up in the lungs and body, causing symptoms like breathlessness, swelling and fatigue. These symptoms tend to become worse over time without treatment.

Stroke

A ‘stroke’ occurs when a part of the brain does not receive adequate blood supply.

Strokes can be from clot which blocks a blood vessel (ischemic) or from a burst blood vessel (hemorrhagic). People with RHD are at risk of ischemic stroke because of blood clots which can form in the heart and subsequently block blood flow to parts of the brain.

Some people living with RHD need to take ‘blood thinning’ medication (anticoagulation) to reduce the risk of stroke.

Arrhythmia

Atrial fibrillation (AF) is an abnormal heart rhythm. People with RHD are at risk of AF because heart valve damage changes the shape of the heart and increased the risk of AF. AF tends to make heart failure worse, increasing shortness of breath, and may cause palpitations. AF also significantly increases the risk of stroke.

Endocarditis

Infective endocarditis (IE) is a bacterial infection on the valves of the heart.  Valves that are already scarred or damaged by RHD are more likely to have IE than undamaged valves.

People with IE have fevers and the heart may be unable to pump blood effectively. It can be difficult to diagnose IE and, even when IE can be diagnosed, antibiotic treatment may be ineffective.

Minimising the risk of IE is an important part of managing RHD. The bacteria that cause IE tend to come from the mouth, so good dental hygiene is an important way to minimize risk. Giving prophylactic antibiotics before dental work and some other procedures is standard in many countries.

Complications in pregnancy

Women with RHD are at risk of significant illness or death during pregnancy and labour. The changes of pregnancy make the heart work harder. Hearts that have been damaged by RHD may not be able to adjust to these changes causing heart failure. The symptoms of heart failure may be confused with symptoms of late pregnancy and go untreated, causing cardiovascular collapse and death. Women who have received heart valve surgery and metal heart valves are at risk of serious bleeding from anticoagulation medication. These medications can also affect the developing baby.

“The high rate of teenage pregnancies combined with an endemic prevalence of rheumatic disease in developing countries results in cardiac disease being one of the most important comorbid states during pregnancy”