Essay Sample on Pathophysiological Process of Rheumatic Heart Disease

Rheumatic Heart Disease (RHD), is a chronic condition that is initially caused by a strep throat infection (Katzenellenbogen et al., 2017). RHD is an inflammation of heart tissues caused by an autoimmune reaction to infection with group A streptococcus. When strep throat is not treated, it progresses to rheumatic fever, which eventually results in rheumatic heart disease. Rheumatism means inflammation of the joints, muscles, and fibrous tissue. Thus, RHD occurs when rheumatic fever reaches and damages the heart tissues. The inflammation and scarring to the heart tissues caused by RHD may result in cardiac insufficiency, damage, and stenosis. Rheumatic fever can affect people of any age but is common among children aged 5-15 years and rare after age 25 (Katzenellenbogen et al., 2017). It mostly occurs in developing countries and is uncommon in developed countries.

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Etiology and Risk Factors of RHD

Rheumatic Heart Disease is usually linked with recurring episodes of Acute Rheumatic Fever (ARF); however, it may sometimes develop after a single attack of ARF (Katzenellenbogen et al., 2017). The risk factor of RHD is untreated or under-treated strep infection. Children with common recurrent strep infections are more at risk for rheumatic fever and RHD. According to a study by Chinyere and Ogiagah (2017) done in Africa, findings indicate that RHD affects more females than males. Vulnerability to RHD is mostly due to genetic causes that are majorly influenced by environmental factors like poverty, poor ventilation, and overcrowding (Maken et al., 2016). Illiteracy and unemployment are also environmental factors that have been indirectly linked with RHD. According to the Genetic and Rare Disease Information Center (2015), Rheumatic fever is caused by various genes interacting together and with environmental factors. Some of the lifestyle influences that may accelerate RHD include excessive smoking and lack of exercise.

The Pathophysiological Process

RHD occurs due to an autoimmune response to rheumatic fever; this means that the body's immune system attacks other parts of the body, thinking it's a disease or bacteria (Katzenellenbogen et al., 2017). Streptococcal A carries a protein on their cell wall known as M-protein. The M-protein has similar structural makeup as cardiac antigens like myosin and valvular endothelium (Katzenellenbogen et al., 2017).

The most prominent in the attack of these cardiac antigens are the subspecies of T lymphocytes, known as the CD4+ T cells and macrophage (Katzenellenbogen et al., 2017). Antigens of group A streptococcus stimulate the activation of CD4+ T cells. These T cells then cross-react with similar peptides in the heart tissue, destroying these tissues being attacked, in this case, the endocardium valve. The resultant effect of all these interactions involves the heart becomes inflamed. After that, the Joints grow swelling and pain due to the buildup of immune complexes, made by antigen-antibody combinations (Gray et al., 2017).

Clinical Manifestation and Complications

Some of the physical signs and symptoms that are important in considering the presence of the disease include fever, swollen, red, and very painful joints, mainly the knees and the ankles. Red lattice-like rush can also be spotted on the chest of the patient, the back, and the abdomen. Other noticeable physical symptoms include discomfort in the chest and shortness of breath and general body weakness (Katzenellenbogen et al., 2017). The main signs that contribute to the diagnosis of the condition are the presence of untreated strep throat including symptoms such as sore throat, swollen tonsils, fatigue, fever, headache, and chills.

Complications of RHD include heart failure, which can be a result of leaking or narrowed valve of the heart (Cunningham, Snyder & Kang, n.d.). RHD may also lead to bacterial endocarditis, which is the infection of the lining of the heart from inside. A heart valve may also rapture due to RHD. If symptoms are left untreated, there is a high risk of heart failure and cardiac arrest, which may cause death.

Diagnostics

Common laboratory diagnostic tests include a blood test, which is useful in showing infection of inflammation. Chest Xray is also a test done to confirm if the heart is large due to large swelling and too many fluids (Canningham, Snyder & Kang, n.d.). A cardiac MRI help shows a detailed image of the heart. Electrocardiogram (ECG) is useful in detecting abnormal rhythms of the heart and some damages that the heart may have (Canningham, Snyder & Kang, n.d.). Echocardiogram test uses ultrasound waves to show the functioning of heart valves on a screen. Test findings are essential because they help to know how much the heart valves are damaged. Severe damage may call for surgery as a treatment option to replace the damaged valves.

References

Canningham, L., Snyder, M., & Kang, S. (n.d.). Rheumatic heart disease - Health encyclopedia - University of Rochester Medical Center.https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00239

Chinyere, O. I., & Ogiagah, O. M. (2017). Prevalence and pattern of heart diseases in a new tertiary hospital in north central Nigeria: an echocardiographic study. Journal of Medicine and Medical Sciences, 8(6), 077-083. DOI: http:/dx.doi.org/10.14303/jmms.2017.085

Genetic and Rare Disease Information Center. (2015, January 11). Rheumatic fever. https://rarediseases.info.nih.gov/diseases/5699/rheumatic-fever

Gray, L. A., D’Antoine, H. A., Tong, S. Y., McKinnon, M., Bessarab, D., Brown, N., ... & Inouye, M. (2017). Genome-wide analysis of genetic risk factors for rheumatic heart disease in Aboriginal Australians provides support for pathogenic molecular mimicry. The Journal of infectious diseases, 216(11), 1460-1470. https://doi.org/10.1093/infdis/jix497

Katzenellenbogen, J. M., Ralph, A. P., Wyber, R., & Carapetis, J. R. (2017). Rheumatic heart disease: infectious disease origin, chronic care approach. BMC health services research, 17(1), 793. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975544/

Maken, Z. H., Ahmed, F., Ferogh, E., & Arumghan, A. (2016). An Epidemiological Analysis of Socioeconomic Risk Factors Among Patients of Rheumatic Heart Disease, Islamabad, Pakistan. Pakistan Journal of Public Health, 6(4), 41-43. DOI: https://doi.org/10.32413/pjph.v6i4.13