Rheumatic heart disease is a complication of rheumatic fever in which the heart valves have been permanently damaged. Recent clinical researches indicate that the mortality rate from this disease remains up to 1.5 % of all causes of death among Thai population. Typically, rheumatic heart disease does not produce any noticeable signs and symptoms in its early stage. In fact, the heart valve damage may start shortly after untreated or under-treated streptococcal infection during childhood. More importantly, rheumatic heart disease remains one of the leading causes of maternal cardiac complications in pregnancy worldwide. If left untreated or treated inappropriately, pregnant patients are at high risks of heart failure and abortion is compulsorily recommended.
Example of rheumatic heart disease in pregnant patient
A 21-year old Nauruan patient was referred to Bangkok Heart Hospital. She was diagnosed with rheumatic heart disease during her first pregnancy. Since she had developed rheumatic heart disease while being pregnant, she entirely lost her hope for keeping her first baby. Nevertheless, new hope had arisen when multidisciplinary team including highly experienced cardiologist, obstetrician-gynecologist and pediatrician collectively agreed that she could be treated safely without the need of abortion. The treatment plans arranged by multidisciplinary team involved:
The contributing factors to successful treatment of this complicated case include the great compliance obtained from the patient and the highly experienced multidisciplinary team specialized in cardiology, obstetrics-gynecology and neonatology. To get pregnant safely, heath check-ups and heart screening remain vital in order to assess related risks and identify any abnormalities before starting pregnancy for healthy lives of mothers and babies.
Get to know rheumatic heart disease
Rheumatic heart disease is described as a complication of rheumatic fever in which the heart valves have been permanently damaged. Rheumatic fever is an inflammatory disease caused by an autoimmune response to a bacterial (streptococcus) infection during childhood. Primary episodes of acute rheumatic fever occur mainly in children particularly in developing regions. From repeated effects of rheumatic fever, it can affect connective tissue throughout the body, especially in the heart valves, eventually leads to rheumatic heart disease with chronic valve damages. Since rheumatic heart disease may not exhibit noticeable symptoms, it is often undiagnosed until reaching certain period of time that aggravates the manifestations such as pregnancy.
Signs and symptoms of rheumatic heart disease
Most common signs and symptoms of rheumatic heart disease include:
Complications of rheumatic heart disease during pregnancy
During pregnancy, there is an increase in blood volume which results in increased pressure on the heart valves. For pregnant women with rheumatic heart disease, an increased pressure on the damaged heart valve leads to increased maternal and fetal risks. These complications might include:
Taking good care of pregnant women with rheumatic heart fever
Special neonatal care of the babies
Intensive care for preterm babies provided by well-trained neonatologists is extremely important since the baby’s organs are not fully developed and some functions might be impaired. During the first 4 hours after delivery, it is a critical period when the baby’s heart tries to function properly to get sufficient blood circulation. Close monitoring is essentially required in order to observe any abnormal signs and provide immediate treatments, if needed, in time.
Although this Nauruan patient was treated successfully, preterm delivery could result in impaired growth and poor development of the baby. To prevent these complications, multidisciplinary team worked collectively to provide the treatment with the best possible outcomes supported by advanced technology in cardiac and neonatal practices. The satisfactory results could be eventually obtained when both mother and baby were safe.
Pregnant women with rheumatic heart disease essentially require comprehensive treatments given by highly expert multidisciplinary team consisting of cardiologists, obstetrician-gynecologist and pediatrician. Expertise in a combination with cutting-edge technology and world-class standard care of Bangkok Hospital and Bangkok Heart Hospital could save the lives of patient and her beloved baby. They could eventually return home with smiles.