Can rheumatic heart disease with enlarged heart be treated with surgery?

Written by Xie Zhi Hong

Cardiology

Updated on January 08, 2025

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Patients with rheumatic heart disease generally present with valvular insufficiency or severe stenosis. If the patient's heart is enlarged and the ejection fraction significantly decreases, for example, if the left ventricular diastolic diameter is greater than 75, and the ejection fraction is less than 30%, the surgical outcome may be poor. This is particularly the case if there is associated pulmonary arterial hypertension, which may lead to no improvement in condition after surgery, indicating a poor surgical outcome. However, if the patient has severe stenosis or insufficiency of the valve function, not performing surgery could further worsen the condition.

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Written by Wang Lei

Cardiology

1min 9sec

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Does rheumatic heart disease require surgery?

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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Written by Xie Zhi Hong

Cardiology

42sec

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Can rheumatic heart disease patients exercise?

Patients with rheumatic heart disease should go to the hospital for assessment, undergo cardiac ultrasound, and perform exercise tests. If the exercise test indicates cardiac function is below class II, or if the six-minute walk test reaches above class IV, exercise can be pursued. If patients have concerns, they can exercise under the guidance of a cardiac rehabilitation therapist at the hospital. For patients with cardiac function class III and above, exercise is not recommended. It is advised that they manage heart failure in the hospital or consider exercise only after surgery and when the condition is stable.

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Written by Xie Zhi Hong

Cardiology

36sec

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Can rheumatic heart disease cause angina?

Rheumatic heart disease most commonly manifests as rheumatic myocarditis, pericardial thickening, or pericardial effusion. The majority of patients also present with mitral valve stenosis and insufficiency, and some also have aortic valve stenosis and insufficiency. When patients have severe aortic valve stenosis or severe aortic valve insufficiency, it leads to insufficient blood supply from the aorta, causing inadequate coronary circulation, which then can lead to angina.

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Written by Wang Lei

Cardiology

51sec

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Is rheumatic heart disease considered a serious illness?

In the case of rheumatic heart disease, it spans different stages of the disease. In its early stage, it can affect the heart valves to a certain extent. However, this impact may progressively worsen over time. Thus, the initial effects on the heart are not severe. Once it causes mitral valve regurgitation, patients often exhibit clear symptoms, such as chest tightness and shortness of breath after activity, and in severe cases, pulmonary edema, coughing, and expectoration of bloody sputum. Severe cases can lead to nocturnal insomnia and orthopnea, presenting with paroxysmal breathing difficulties. These symptoms indicate cardiac function failure, a serious condition. Therefore, inadequate or delayed treatment can be life-threatening.

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Written by Zhang Yue Mei

Cardiology

46sec

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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.