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Bacteria and the Heart: Understanding Rheumatic Heart Disease

Dr. Tariq Malik

2 min read

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Rheumatic heart disease (RHD) is a chronic and progressive condition that is defined by potentially fatal damage to the heart’s lining, muscles, and particularly, valves. A complication of Acute Rheumatic Fever (ARF), RHD is the most common heart condition in people under 25. However, both conditions are easily preventable and can be treated by a top cardiologist in Pakistan.

Acute Rheumatic Fever:

At times, a strep throat infection caused by the bacteria ‘A streptococcus’ can negatively affect the immune system, which then reacts to the infection by causing inflammation within the connective tissues of various parts of the body, namely the joints, skin, brain and heart, and is now known as Acute Rheumatic Fever. Although ARF can develop at any age, children between 5-15 are among the most commonly affected.

How ARF Damages The Heart:

Cardiac inflammation due to a single or recurrent ARF episodes can either stretch or scar the heart valves. Stretched valves are unable to close properly (leaky valve) and cause blood flow in the opposite direction, while blood flow may be blocked in case of scarring due to heart valves not opening properly. In both cases, the heart has to work harder to pump blood efficiently. The resultant damage, if left untreated, leads to possibly fatal complications like stroke and congestive heart failure (inability to properly maintain blood circulation) over time.


Since RHD usually starts to develop 10-15 years after an ARF attack, most patients may go years without noticing any definitive symptoms of valve damage. In those who do, commonly observed symptoms include:

  • Chest pain
  • Heart palpitations
  • Weakness and fatigue
  • A thumping sensation in the chest
  • Swollen legs, face, ankles, wrists and/or stomach
  • Breathlessness following physical activity or while lying down
  • Paroxysmal Nocturnal Dyspnea (waking from sleep with the need to sit or stand up)
  • Hearing a Heart Murmur (when blood leaks around the affected valve) or Rub (when inflamed heart tissues rub against each other) through a stethoscope


If left untreated, RHD can cause the following complications:

  • Stroke
  • Ruptured heart valve
  • Pregnancy and delivery complications
  • Blood clots in the lower heart chambers
  • Enlarged heart due to high-force pumping
  • Heart failure due to narrowed or leaky valves
  • Bacterial Endocarditis (infection of heart’s inner lining)
  • Atrial arrhythmia (irregular heartbeat in the upper heart chambers)
  • Recurrent Pulmonary Emboli (blocked pulmonary arteries in the lungs due to blood clots)


Treatment depends upon the amount of heart damage, and is largely focused on treating and preventing ARF recurrence to avoid further heart damage:

1- ARF Prevention and Treatment

Patients are initially given antibiotics, particularly penicillin, for strep infection treatment. In case of a penicillin allergy, erythromycin may also be prescribed. After the infection is treated, prophylactic antibiotics like penicillin are prescribed to prevent a recurrence and are continued until the patient is 20-40 years old depending upon whether they have RHD or not. Bed rest for 2-12 weeks is also recommended alongside medicinal treatment.

2- In Case of Cardiac Inflammation:

While high-dose aspirin and other anti-inflammatory medications along with steroids, and salicylates/NSAIDS are prescribed to reduce inflammation within the heart and other parts of the body. Patients may also be required to take antibiotics before any medical procedures, like dental surgery, for the long-term in order to avoid inflammation.

In addition, getting regular flu shots, practicing good oral hygiene (to prevent oral bacteria from entering the bloodstream and causing inflammation), and adequate prenatal care in case of pregnancy is also recommended.

3- In Case of Valve Damage:

If a valve becomes stretched and leaks severely enough to cause heart enlargement, surgical repair of the damaged valve may be required. In the event of extreme damage, replacing it with an artificial valve may be the only option. Conversely, a scarred valve may be expanded by surgically inserting a balloon, although a severely narrowed valve may also require replacement.

4- Lifestyle and Dietary Restrictions:

Along with complete bed rest until the infection fades and condition stabilizes, fluids and sodium-containing foods should be restricted in patients with congestive heart failure. Moreover, potassium supplements may also be required if the treatment plan includes diuretics or steroids.

Patients with an RHD diagnosis should attend regular follow-ups and report to their physicians immediately in case of symptomatic aggravation or any new symptoms. You can also book an appointment with a top Cardiologist in Lahore, Karachi and Islamabad through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your cardiac concerns.

Disclaimer: The contents of this article are intended to raise awareness about common health issues and should not be viewed as sound medical advice for your specific condition. You should always consult with a licensed medical practitioner prior to following any suggestions outlined in this article or adopting any treatment protocol based on the contents of this article.

Dr. Tariq Malik
Dr. Tariq Malik - Author Prof. Dr. Tariq Mahmood Malik is a cardiologist of international stature and fame. He returned to Pakistan at the peak of his career in 1993 and is now in full time practice of Cardiology and internal Medicine. You can seek appointment with him through oladoc.

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