Post-rheumatic heart valve disease

The article is professionally consulted by Master, Doctor Hoang Thi Hoa - Cardiologist - Department of Medical Examination and Internal Medicine - Vinmec Ha Long International General Hospital.

Post-rheumatic heart valve disease is a disease that occurs in the late stages of rheumatic heart disease. Initially, the disease has many features similar to the common cold, but when the heart valve disease occurs, the patient feels more breathless, the degree of shortness of breath gradually increases over time.

Post-rheumatic heart valve disease is an autoimmune disease caused by group A beta-hemolytic streptococci. It begins with a sore throat, which usually lasts about 2 weeks. This is enough time for the body to produce antibodies to fight the infection. However, because the heart muscle and heart valves are similar in structure to bacterial cells, the immune system mistakenly recognizes and attacks them. The result is damage to the heart valves, causing the heart valves to thicken and stick together. Along with calcium deposition, the valve leaflets become stiffer, causing narrowing and regurgitation of the heart valve. Therefore, it can be said that valvular heart disease is one of the complications of rheumatic heart disease.
The relatively low incidence (about 3%) indicates that only a few people have antigens similar to streptococci. Antigens that cause the immune system to mistakenly recognize and attack have a structure:
The hyaluronate component of the heart valve glycoprotein is similar to the hyaluoronate of the streptococcal membrane. The myocardial fibrous membrane resembles the antigen of the streptococcal membrane. Myosin of the myocardium resembles the M protein (the main toxin of group A hemolytic streptococci) of streptococci.

In addition, rheumatic heart disease also has a cell-mediated immune response involving T lymphocytes and macrophages, so damage to the heart, including heart valves, can be caused by both mechanisms.

The first sign of valvular heart disease after rheumatic heart disease is often shortness of breath, which occurs mainly during heavy work and strenuous exercise. The degree of shortness of breath will gradually increase over time, people with late detection of the disease may present with shortness of breath with light activity or more severe than even at rest.
In addition, the patient may cough with a little blood. This sign is easy to confuse patients and doctors with respiratory diseases. Therefore, the disease is rarely detected early.

A common complication of post-rheumatic heart valve disease is heart failure. The heart valve does not work properly, reducing the efficiency of the blood pump. This causes the heart to contract more than usual to ensure adequate blood supply to the body. Over time, prolonged exertion will make the heart tired and weak, leading to heart failure.
In addition, post-rheumatic valve disease also causes many other serious complications such as atrial fibrillation, thrombosis, pulmonary hypertension, endocarditis, stroke, kidney failure, etc.

It is very difficult to cure rheumatic heart disease, even if the patient has had surgery to replace the heart valve, after treatment, it is still necessary to take preventive medicine to avoid dangerous complications that may occur.
4.1 Medical treatment The groups of drugs commonly used in the treatment of valvular heart disease after rheumatic heart disease include:
Diuretics: Diuretics have the effect of removing excess fluid from the body, reducing the symptoms of cough, edema, difficulty breathing. Antiarrhythmic drugs: Antiarrhythmic drugs help control heart rate, reduce nervousness, palpitations. ACE inhibitors: ACE inhibitors work to relax blood vessels, lower blood pressure, and reduce blood pressure on the heart valves. Beta-blockers: Beta-blockers help treat high blood pressure and reduce heart rate. Anticoagulants: Anticoagulants work to prevent blood clots from forming on the heart valves, causing them to tear the valves and move into the blood vessels, causing embolism.

4.2 Surgical treatment Surgical treatment of valvular heart disease after rheumatic heart disease has 2 main methods: valve shaping and valve replacement. In addition, for the case of heart valve stenosis, the patient can be dilated by percutaneous vascular intervention.
Heart valve dilation Cardiac valvuloplasty is a procedure with low cost and higher safety than the traditional open surgery method. The procedure is performed as follows: First, a catheter is threaded through the lumen of a blood vessel from the femoral vein in the groin to the heart valve. The catheter tip has a balloon, when inflated, the valve hole will be enlarged. With this method, the patient does not need surgery and the hospital stay is short.

Valve shaping Valve shaping is applied to heart valves that have not been severely damaged. For heart valve stenosis, the surgeon will cut and fix the stuck valve edges. As for the regurgitation of the heart valve, the surgeon will cut, suture the ligament, place the valve ring, and narrow the diameter of the valve ring. The advantages of valvuloplasty are reduced risk of valve infection and shorter duration of anticoagulation (median 6 months, in the absence of other indications).
Heart valve replacement Heart valve replacement is applied to heart valves that have been severely damaged, unable to shape the valve anymore. There are two types of heart valves: mechanical heart valves and biological heart valves:
Mechanical valves: Mechanical valves are made from artificial materials (titanium, carbon...). The advantage is high durability, can be used for a lifetime. The disadvantage is that patients need to be monitored and treated with anticoagulants for life. Mechanical valves will be suitable for men and women after reproductive age.
Biological valves: Biological valves are made from natural materials (pork, bovine pericardium, etc.) that have been processed to remove components that cause transplant rejection or valves taken from organ donors. The advantage is that the duration of anticoagulation is shorter (usually 6 months after surgery). The downside is that the valve will degenerate over time, on average used for 10-15 years depending on the location of each person; Surgical costs are higher than mechanical valves. Biological valves are suitable for women of reproductive age.

Maintaining a scientific lifestyle can help patients reduce the risk factors for severe heart valve disease:
Increase intake of green vegetables, fresh fruits, whole grains, white meats such as Fresh fish, chicken, etc. Limit foods high in fat (fatty meat, fast food, fried food...) Eat less salty Exercise every day with moderate and suitable activities health conditions such as walking, cycling, swimming, yoga, etc. Post-rheumatic heart valve disease is an autoimmune disease with symptoms such as coughing, shortness of breath on exertion. The disease can be treated medically or surgically depending on the condition of the disease. Accordingly, if not treated, it can lead to heart failure, seriously affecting the patient's health. Therefore, when you see signs and symptoms of the disease, it is necessary to immediately go to a medical facility for examination and timely intervention.
To protect heart health, customers can sign up for Cardiovascular Screening Package - Basic Cardiovascular Examination of Vinmec International General Hospital. The examination package helps to detect cardiovascular diseases early through tests and modern imaging methods. The package is open to all ages and genders and is essential for people at risk of cardiovascular disease or a family history of heart disease.

Master. Hoang Thi Hoa has more than 10 years of experience in the field of Cardiology, especially in the field of cardiovascular emergency and echocardiography. Doctor Hoa used to be the Deputy Head of Cardiology Department of Quang Ninh General Hospital before working at Vinmec Ha Long International Hospital.
If you notice unusual health problems, you should visit and consult with a specialist.