heart problems caused by rheumatic fever

[csutherland]

I've become confused about the connection between rheumatic fever and heart disease. Here's the deal: I had it as a small child, even though I don't remember anything about it except I used to have lots of leg aches. I was probably in my 30's when the issue came up on a new dentist's questionnaire. Ever since, I've been taking antibiotics before dental work. This was long before Jerry came up with his valve problems so I was just clueless about the reasons for them and never worried at all.

Last week I had a vocal cord polyp removed surgically and while pre-admitting I asked about whether I'd need antibiotics beforehand. The nurse asked me if I received antibiotics for the rheumatic fever when it happened and I said I assumed so. I was born in 1942 and my parents took me to the doctor when I needed to go. I believe penicillin was around. The nurse said that if I was treated for the RF then there was no risk of developing a valve problem down the road. Is that true? If so, why am I taking a handful of pills before every dental app't?

[bvdr]

I've become confused about the connection between rheumatic fever and heart disease. Here's the deal: I had it as a small child, even though I don't remember anything about it except I used to have lots of leg aches. I was probably in my 30's when the issue came up on a new dentist's questionnaire. Ever since, I've been taking antibiotics before dental work. This was long before Jerry came up with his valve problems so I was just clueless about the reasons for them and never worried at all.

Last week I had a vocal cord polyp removed surgically and while pre-admitting I asked about whether I'd need antibiotics beforehand. The nurse asked me if I received antibiotics for the rheumatic fever when it happened and I said I assumed so. I was born in 1942 and my parents took me to the doctor when I needed to go. I believe penicillin was around. The nurse said that if I was treated for the RF then there was no risk of developing a valve problem down the road. Is that true? If so, why am I taking a handful of pills before every dental app't?

What the nurse said was incorrect. Rheumatic fever does not always lead to rheumatic heart disease though. The treatment for rheumatic fever however is designed to try to prevent the development of rheumatic heart disease. Rheumatic fever is thought to be an autoimmune response to a strep infection and can recur with subsequent infections. The autoimmune type response usually progresses slowly and the tissue most often targeted for destruction is the heart valves. The mitral is the valve most often affected with the aortic valve being the next common. Mitral stenosis in an adult is nearly always caused by rheumatic heart disease whether it was diagnosed as a child or not.

Sometimes it takes 20 or 30 years for the damage to become severe enough to cause symptoms. In your case, if you had rheumatic heart disease it probably would have showed up by now. An echo cardiogram would most likely answer your questions. Antibiotics all these years were a good idea because you would have been more susceptible to endocarditis if you had any valve damage at all.

[Lisa in Katy]

My dad had RF as a child that did not lead to permanent heart disease, but he still takes antibiotics for dental visits, surgery, etc. because the risk of reoccurrence is high. I had RF that did lead to heart disease and I also take antibiotics for everything. In fact, for years I took daily penicillin, but still took even more antibiotics when I went to the dentist.

The nurse was wrong.

[RCB]

I've become confused about the connection between rheumatic fever and heart disease. Here's the deal: I had it as a small child, even though I don't remember anything about it except I used to have lots of leg aches. I was probably in my 30's when the issue came up on a new dentist's questionnaire. Ever since, I've been taking antibiotics before dental work. This was long before Jerry came up with his valve problems so I was just clueless about the reasons for them and never worried at all.

Last week I had a vocal cord polyp removed surgically and while pre-admitting I asked about whether I'd need antibiotics beforehand. The nurse asked me if I received antibiotics for the rheumatic fever when it happened and I said I assumed so. I was born in 1942 and my parents took me to the doctor when I needed to go. I believe penicillin was around. The nurse said that if I was treated for the RF then there was no risk of developing a valve problem down the road. Is that true? If so, why am I taking a handful of pills before every dental app't?

One of the problems before the '60 was the protocol for treating RF
was to take antibiotics till your fever went down. This sometimes happen in a few days and people would stop their meds. As any microbiologist will tell, this will sometimes weaken the germ, but won't kill it so it can come back stronger than ever. Then your body starts to attack it even more strongly- sometimes even attacking the body itself. The scarring that takes place, is what causes RF to be so hard on the valves.
Today, doctors alway tell anyone taking antibiotics, finish the whole bottle, even if you feel better. Something that simple has reduce the rate of RF so that it is very rare today- Thank GOD!

[McCln]

Rheumatic fever generally enlarges the heart at that time. It becomes a persitant condition for life. I had an uncle who had the same thing, the fever and had enlarged heart for life. You need to get with a cardiologist and get regular checkups to keep it regulated. This is not to scare you, you did not know. Talk with your primary doctor and get a referal for the cardiologist. You are welcom here, we all have various degrees of heart conditions. Ask us all the questions you need to. Education is knowledge is key to good health.

[lance]

I was in my lte teens when rheumatic fever developed following a sore throat. Being in my teens and always healthy and indestructible (of course) I totally disregarded the sore throat and continued my daily routine.

When the fever came I ignored that too until one night I felt really awful and was taken to the ER. By that time I couldn't remember my name nor where I lived. Rheumatic fever was diagnosed following a blood test. So I went on with my life and did all the things I wanted to to feeling there would be a time when I couldn't. The disease progressed very slowly and insidiously.

It took about 40 years for the symptoms of valve disease to cause problems --experienced congestive heart failure (it was hard to ignore not being able to breathe) leading to MVR five years ago. There is some heart enlargement as well.

I always take antibiotics prior to anything especially dental visits and all is well and get on with things as well as I can.

Cheers

[csutherland]

Well good grief! I thought that nurse was awfully sure about some things that didn't sound right to me. Thanks for clearing it up. I'm wondering if my PCP would even refer me. I do have some SOB (more like breathlessness) and have had for years; I occasionally feel a little "heaviness" or something in my chest and left shoulder & arm that I assumed was stress. Isn't that what women's problems always are? A murmur has never been detected. That nurse was the last one to thoroughly listen and pronounce me OK!

[Nancy]

Joe was a young teenager when he had rheumatic fever. He had his aortic valve replaced when in his forties. He was treated with sulfa drugs and not penicillin, and was in the hospital for a year.

It never leaves your system.

[geebee]

Nurse was WRONG, WRONG, and WRONG!!!!

As Nancy said, RF bacteria (or whatever it is) hangs around forever. Even if you do not have symptoms, the "stuff" is in there waiting for an opportunity to destroy your valves.

Always take antibiotics before any surgical procedure that could cause bleeding such as dental cleanings, tooth extractions, colonoscopy, mole removals, anything being "snipped", etc.

With the symptoms you describe, it would be beneficial to visit a cardio just to get checked out. You can talk to him/her about when to take antibiotics and when they are not needed.

Best of luck.

[Granbonny]

Im age 65 and can still remember..I think it may have been around 1948..I would have been age 8 and my baby sister..age 3..We were visiting an Uncle and Aunt ...way down in the Piney Woods of Alabama..when my little sister got sick..Mama found her a country doctor that told my Mama..Be very careful with her..She could get Rheumatic Fever.. We drove back home and I was in the back seat of car..thinking she was going to die..That word Rheumatic Fever was so scary... The reason we came home..my Aunt was mad because Mama wanted to run the new..electric fan on my sister to break the fever. They had just gotten electricity..Yes, in 1948. Guess she didn't get it..Still alive and kicking..and healthy...My point..doctors knew back then..Rheumatic fever. can cause serious problems...Bonnie

[RCB]

Sometimes when people say things they may make a statement which does not really describe exactly what is going on. let me try to clear up the confusion or make a more precise statement about RF.

RF is, as Betty explained, thought to be an autoimmune(arising from and directed against the individual's own tissue) which is caused when some human are infected with group A streptococci, a bacteria from the family Lactobacillaceae. It causes strep throat, scarlet fever, impetigo,endocarditis,
cellultis-erysipelas and RF.

The process by which a strep infection developes in to RF is still not completely understood. Generally, it is thought that some antibodies in the white blood of certain individuals become so reactive to some amino acids in the celluar walls of the bacteria, that it causes kind of "a fit of rage" whereby
these antibodies go about attacking protein- friend or fowl. The bodies own defences start to attack itself- kind of a friendly fire. The reaction is automatically started by the immune system, hence the name "autoimmune".

The key thing to remember about RF and other autoimmune diseases, is that it is the immune system that attacks the valves and other parts of the body, not the strep bacteria. The strep infection is more of a trigger than a bullet.

When you take an antibiotic to kill strep, you should always finish the whole
script because you will start feeling better before the strep has been completely killed. During the process of using your meds, your immune system
starts to recognize the bacteria as something to be attacked and will kill effectively all of it and you will have been said to attain immunity to the germ.

It is thought that people who get RF never lose there SUSCEPTIBILITY to the disease, although they seem not as prone to it with age. However, the bacteria is all arouund us in nature and is just waiting to invade our bodies given the right conditions.

Therefore, it is accurate to say we can completely get rid of the strep within
the body, but certain individuals will always have a susceptibility to a strep reaction which can cause RF.

[Nancy]

Here is a good and long article on rheumatic fever. Anyone who has had it once, should do everything possible to prevent recurrence at any time in their life. In other articles I have read there is also caution about travelling to third world countries.

In another extremely technical article (see second site), there is mention of many people not remembering having had the initial pharyngitis which precedes RF, and so many people have mentioned that they don't remember having had it.

http://www.emedicine.com/ped/topic2006.htm

http://www.rheuma21st.com/archives/c...man_fever.html

[bvdr]

RCB, that was a good post. Nancy, as usual, posted great articles.

Synopsis:

STREP THROAT is treated in hopes of preventing the autoimmune response that may cause RHEUMATIC FEVER in certain individuals.

If RHEUMATIC FEVER does develop then it is treated to hopefully prevent the development of RHEUMATIC HEART DISEASE.

If RHEUMATIC HEART DISEASE develops then treatment is aimed at limiting recurrances of RHEUMATIC FEVER that would cause the whole process to worsen or accelerate the damage being done. Treatment is also aimed at treating symptoms and preserving/improving heart function. That is why so many of us need to have destroyed valves replaced.

Rheumatic heart disease is a life-long condition.

[RCB]

I appreciate both of you for what you added here. Nancy for the knowledge base that her research contributes to the understanding of RF. Betty for summarizing so clearly what I said so clumsily. What would this place be without the two of you!

[Nancy]

Joe lives with the after-effects of RF on a daily basis. Almost every aspect of RF he has had, except possibly chorea.

And the conditions continue to mount up as his life continues.

Even his pulmonary hypertension has been mentioned in relation to RF.

It's insidious and subtle symptoms can and have been misdiagnosed throughout Joe's life.

The need for careful medical attention is apparent.