Friday, September 27, 2013

How Can a Sore Throat Lead to Heart Disease? World Heart Day September 29

When I was a child, my babysitter’s son became very ill with rheumatic heart disease. I remember that he had to go back regularly for injections for months after he was discharged from the hospital, but we didn’t know what they were or what they were for. We just knew not to knock him hard on the side of his butt that next day. We were in awe that we knew someone who had been so sick, but we were scared too, because it was just so unknown to us.

It was when I was older, I learned that Paul had had strep throat that had not been treated. As happens sometimes, the infection, caused by Group A streptococcus, can lead to acute rheumatic fever (ARF). The symptoms of ARF include rash, fever, and painful and swollen joints. This can progress to permanent damage of the heart valves.

Concern about rheumatic heart disease (RHD) is still present. While in many developed countries, a diagnosis of strep throat leads to antibiotic treatment, usually penicillin, this isn’t so easy in many countries in the developing world. Interestingly, researchers learned that most patients in South Africa who had RHD and their parents or guardians had never heard of it before they became ill. In Tanzania, it was the same.

According to a press release issued by the World Heart Federation (WHF), “Currently the burden of disease of RHD is conservatively estimated at 15.6 million prevalent cases with 282,000 new cases and over 233,00 deaths per year.” That being said, experts believe that these numbers are nowhere near the real numbers yet.

The biggest concern is there is no guaranteed supply of the type of penicillin (benzathine penicillin G/BPG) that is needed to not only treat the disease, but to prevent the disease from progressing further.

As with so many other illnesses around, RHD is a preventable one, but it can only be prevented if infections are detected and for that, there must be awareness. There is a push in the developing countries to include RHD alongside the importance of treating more known but fatal diseases such as malaria, HIV, and tuberculosis, rather than as an afterthought.

There is proof that paying attention to rheumatic fever and heart disease works. The WHF refers to a model implemented in Martinique, Guadeloupe, and Cuba, comprehensive 10-year programs involving education, awareness strategies at all levels and primary and secondary prevention that were delivered through a registry. “A rapid decline in ARF incidence was achieved at a modest cost with overall reductions of between 74 percent and 86 percent observed,” said the organization.

But you don’t need to be in a developing country to develop RHD. If you suspect that you have an infection, get it checked. Don’t forget, I work closely with Sepsis Alliance and we have seen all too often how an infection lead to something much more serious and with fatal results.

World Heart Day is Sunday, September 29. We know a lot about heart attacks and heart disease brought on by high cholesterol and high blood pressure. How many of you knew about rheumatic heart disease?