Does rheumatic heart disease require surgery?

Written by Wang Lei
Cardiology
Updated on September 28, 2024
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Patients with rheumatic heart disease primarily have involvement of valvular lesions, with the most common being accumulation in the mitral valve, leading to mitral stenosis. In the early stage of the disease, mitral stenosis often has no clinical symptoms and can only be detected through physical examinations, such as auscultation, which may reveal mitral valve murmurs. For patients with asymptomatic rheumatic heart disease, conservative treatment is primarily advised, which includes rest and reducing cardiac load to avoid surgery. Additionally, for severe rheumatic heart disease, mitral stenosis can be very serious, affecting the patient's cardiac function and causing symptoms such as chest tightness and fatigue after activity, and even paroxysmal nocturnal dyspnea and inability to lie flat at night. In such cases, surgical treatment is required, such as mitral valvuloplasty or prosthetic valve replacement surgery. Thus, surgery is necessary in the late stages of rheumatic heart disease.

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Can rheumatic heart disease be inherited?

Rheumatic heart disease is not hereditary and it is not a genetic disease. Rheumatic heart disease is a hypersensitivity disease caused by an infection, especially following a streptococcal infection. This type of infection leads to the body producing antibodies. In some individuals, these antibodies combine with antigens, causing inflammation of the collagen tissue and affecting the heart. This results in inflammatory lesions on the heart valves, causing the valves to become narrowed or fail to close completely, leading to pathological changes known as rheumatic heart disease.

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Written by Xie Zhi Hong
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The causes of syncope in rheumatic heart disease.

The most common manifestation of rheumatic heart disease involves the mitral valve, leading to severe stenosis and insufficiency of the mitral valve, and decreasing the amount of blood returning to the heart. At this time, there is not enough blood returning to the heart, and naturally, the amount of blood pumped out is reduced. If it is extremely severe, it can lead to fainting; this is the first scenario. The second scenario is rheumatic heart disease affecting the aortic valve, which can also result in insufficient blood being pumped out, causing ischemia and hypoxia in the cerebral arteries, leading to fainting. Another situation is related to heart arrhythmias, which are divided into two types. One type occurs when rheumatic heart disease is very severe, potentially causing atrial fibrillation. Some patients with cardiac bypass might experience ventricular fibrillation, leading to fainting. Additionally, there is a scenario where severe rheumatic inflammation causes dysfunction in the heart's conduction system, leading to conditions similar to sick sinus syndrome or complete atrioventricular block, causing significantly slow heart rhythms, which may also lead to fainting.

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Do rheumatic heart disease joints feel cold?

Rheumatic heart disease does not cause cold joints during an attack. The main clinical symptoms are primarily heart failure or arrhythmias. However, due to the underlying rheumatic heart disease, there is rheumatic fever. If it is in the acute phase of rheumatic fever, cold joints, swelling, and pain may occur. It is necessary to conduct further tests including rheumatic factor, erythrocyte sedimentation rate, C-reactive protein, etc., to clarify the specific cause of the cold joints. Treatment can be directed towards the symptoms that appear. The main focus during an attack of rheumatic heart disease should be on managing heart failure and arrhythmias, maintaining heart function, reducing the burden on the heart, and controlling common arrhythmias, such as episodes of atrial fibrillation, among others.

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Rheumatic heart disease contraindications

Patients with rheumatic heart disease must avoid emotional excitement, as it can lead to an increased heart rate and an increased burden on the heart. They must also avoid overexertion, as it can exacerbate heart failure, and a high-salt diet, as consuming too much salt can lead to an increased fluid volume, worsening heart burden and potentially inducing or worsening heart failure. Patients with rheumatic heart disease should generally maintain a pleasant mood, rest adequately, avoid overexertion, eat light and easily digestible foods, and have a high-protein diet. They should also avoid cold and prevent colds to avoid worsening the burden on the heart and the symptoms of heart failure.

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The difference between rheumatic heart disease and myocarditis

Rheumatic heart disease refers to changes in the heart and heart valves caused by a disruption in the body's immune system following infection by Group A Streptococcus. Some also exhibit signs of heart inflammation and pericardial effusion, commonly presenting mitral stenosis, aortic valve stenosis or insufficiency, and tricuspid valve insufficiency. Myocarditis, on the other hand, refers to direct invasion of the heart muscle by viruses or bacteria, leading to heart muscle damage and cardiac dysfunction. Some cases present with arrhythmias, while others exhibit heart failure or shock, which can be severe enough to cause death. Generally, rheumatic heart disease has a longer course of illness, whereas myocarditis tends to improve within about two weeks. However, fulminant myocarditis has a high mortality rate, often accompanied by symptoms of heart failure, and some patients may suffer from long-term arrhythmias as a complication.