Rheumatic fever is not actually a cardiac (heart) disease, since it affects other parts of the body. We are mentioning it here because the most important consequence of rheumatic fever can be a heart failure. Rheumatic fever begins with a throat infection caused by some types of streptococci. After the streptococcal infection, a general illness follows, and the main symptoms are elevated temperature and pain in the joints, but the disease often causes inflammation and damage to various tissues in the body.
The disease can affect all the heart’s tissues, including pericardium. However, the disease commonly attacks the valves and the endocard (inner lining of the heart). In the past, heart problems were much more frequent than joint disorders in people with rheumatic fever; until recently, heart disease accounted for 75% of all cases. But today, the picture is changing due to the general application of antibiotics, and nowadays joint disease are more common than heart diseases in people who have had rheumatic fever.
The most common symptom is a sore throat that does not last long; after a week (or, at most, six weeks) you will start feeling bad and feverish. After that, the symptoms will depend on the organ (or organs) that has been affected by the disease. Distinguished symptoms in cases of heart inflammation occur rarely. It is easier to recognize the joint disease, which usually affects the knees and ankles, but may also extend to the fingers, the hand joints and shoulders. Inflamed joints, which are the result of rheumatic fever, are likely to be swollen, sensitive to touch, hot, red and very painful. Inflammation usually affects more than one joint.
In as many as 10% of cases of rheumatic fever, there is a complication, called a chorea, two to six months after a streptococcal infection. Since chorea attacks the brain, the main symptoms are the unexpected twitching of the fists, hands, and face. A speech can be temporarily incomprehensible. But, there is no permanent damage.
A red rash in the form of a ring with a white center can also develop. Such rashes (may be several) usually occur on the torso; after the disappearance of one rash, another one appears. Rheumatoid nodules may also appear on the joints of the fingers, the wrist, on the elbows or on the knees. The rash is not itchy, the nodule does not hurt, and it all disappears after some time.
Rheumatic fever was once more widespread than today; penicillin is an effective weapon against strep throat infection. But, children and adults under the age of 30 are still quite sensitive. Up to 1% of girls and boys in adolescence show signs of having – or that they had – a heart disease associated with rheumatic fever.
As soon as you get rheumatic fever, you can expect new attacks. Before, when preventative treatment was not possible, every fourth child, who had suffered from a rheumatic fever at the age of 4 to 13, would experience a recurrence. Dangers have been significantly reduced by antibiotic therapy. However, in 60% of cases of rheumatic fever, there is still a possibility of heart valve disease. The severity of heart disease is often proportional to the number of rheumatic fever attacks. There is also a slight risk of cardiac decompensation as a result of a very strong seizure.
What to do?
Always contact your doctor if someone in your family has painful, swollen joints with an increased temperature. During the examination, the doctor will pay special attention to the heart, checking it with a stethoscope (phonendoscope). Diagnostic tests include blood sample analysis to determine changes that may have occurred as a result of rheumatic fever, X-rays of the chest to see if the heart has enlarged, and electrocardiograms (EKG). If the joint is swollen, a small amount of fluid will need to be extracted (under local anesthesia) to detect the cause.
If there are signs of heart disturbances, your doctor will keep you in bed until he is satisfied with your condition. Lying is recommended even when the joints are affected. While you are lying, you will probably get regular aspirin doses against inflammation and to relieve pain. If the inflammation does not respond to this therapy, a corticosteroid antiinflammatory can be given as a second possibility.
Long-term treatment of antibiotics is almost always applied in people with rheumatic fever. Precautionary measures against streptococcal infections significantly reduced the incidence of seizures; today, only 4% of patients have more than one seizure. As with the number of seizures, the risk of heart disease also increases, so this is why it is important to reduce the number of seizures. Antibiotics should be taken regularly for years, which means that younger people will need to take antibiotics even in adulthood.
After a rheumatic fever, the number of symptoms, if there are any, will be small, as the joints and skin are usually completely healed. There is a risk of heart valve damage, especially in people who had multiple seizures. However, with the modern treatment of heart valve disorders, the odds are good.