Rheumatic heart disease is caused when rheumatic fever – an inflammatory disease that affects the heart, brain, skin and joints – causes damage to the heart valves.

Rheumatic fever is a serious but preventable autoimmune disease that develops when streptococcal infections like strep throat or scarlet fever are left untreated. Children who have repeated strep throat infections are most at risk for developing rheumatic fever and rheumatic heart disease.

Rheumatic heart disease can begin quickly after a strep infection or years later; over time, heart valves can become scarred which leads to leaking or narrowing.

Rheumatic fever mainly affects Māori and Pacific children between 4 and 19 years old, especially if other family members have had the disease.

Many young people who develop rheumatic heart disease need lifelong antibiotic injections and blood-thinning medication.

Common symptoms of rheumatic fever:

• Fever
• Painful joints, especially knees, ankles, elbows and wrists
• Fatigue
• Heart murmur
• Pain that moves between different joints
• Jerky, uncontrollable body movements
• Painless nodules under the skin and/or rash consisting of pink rings with a clear centre (both are rare symptoms)

Symptoms of heart valve damage due to rheumatic heart disease:

• Shortness of breath
• Chest pain or discomfort
• Fatigue
• Swelling of the stomach, hands or feet
• Rapid or irregular heartbeat

Treatment of rheumatic heart disease

There is no cure for rheumatic heart disease; the damage to the heart valves is permanent. Surgery is often required to replace or repair the damaged valve or valves in patients with severe rheumatic heart disease. Medication may also be needed to treat symptoms of heart failure or heart rhythm abnormalities depending on the severity of the disease. Medications to thin the blood and reduce the risk of blood clots may also be needed.

Further reading:

• Starship Clinical Guide – Rheumatic Fever
• Kids Health NZ – Rheumatic Fever and RHD

Kawasaki disease is one of the most common causes of acquired heart conditions. It mostly affects children under five and is more common in boys.

It’s unknown what causes KD, although it’s believed it can be triggered by an infection. If symptoms are recognised at an early stage and treated, most children make a full recovery. However, without treatment, one in four children with KD will develop coronary artery dilation, putting them at risk of heart disease.

Sign and symptoms of Kawasaki disease:

• Fever
• Spotty rash on the chest, back, abdomen or groin
• Red eyes or light sensitivity
• Swollen or cracked lips
• A red tongue
• Swollen hands and feet
• Redness of the palms and soles
• Swollen lymph nodes in the neck

Treatment of Kawasaki disease

Treated in the hospital, the standard initial treatment is intravenous immunoglobulin (IVIG) and aspirin. Given early in the illness, IVIG can reduce the risk of coronary artery issues, and the aspirin reduces fever, pain and joint swelling and can reduce the risk of blood clots forming.

Further Reading:

• CHF UK – Kawasaki Disease

All types of heart inflammation, causes can include bacterial or viral infection, autoimmune diseases such as rheumatoid arthritis or lupus or cancer.

Myocarditis: The myocardium (heart muscle) becomes inflamed. Although it will often heal on its own a severe case can weaken a child’s heart and potentially lead to abnormal heart rhythms, blood clots or heart failure.

Endocarditis: An infection that invades the heart valves, most often caused by a bacterial infection. Although rare, it is more common in those with congenital heart or valve conditions.

Pericarditis: The pericardium (sac that surrounds the heart) becomes inflamed or irritated. Most cases will be mild and only require medication, but in rare cases too much fluid builds in the pericardium.

Depending on the area of the heart affected, signs and symptoms may include:

• Fever or chills
• Fainting
• Fatigue, weakness or nausea
• Rapid breathing or shortness of breath
• Arrhythmia (irregular heartbeat)
• New heart murmur or changes to an existing one
• Chest pain
• Heart Palpitations
• Night Sweats
• Pain or shortness of breath when lying down

Treatment: For many patients heart inflammation improves on its own without intervention. For others, treatment options can include surgery and/or medication.

Long QT syndrome (LQTS) is rare disorder where your heart takes longer than usual to recover after each beat. It affects one in 5,000 people. At its most basic level, long QT syndrome is an electrical problem. Long QT syndrome be inherited or acquired. In other words, it can have root causes in your genes and start at birth or come later in life due to some other cause.

Further reading:

• CIDG NZ – Long QT Syndrome
• Starship Clinical Guidelines – Long QT Syndrome
• WebMD – Long QT Syndrome

An arrhythmia is an irregular heartbeat. It means your heart is out of its usual rhythm. It may feel like your heart skipped a beat, added a beat, or is “fluttering.” It might feel like it’s beating too fast (which doctors call tachycardia) or too slow (called bradycardia). Or you might not notice anything.

Arrhythmias are divided up by where they happen. If they start in the ventricles, or lower chambers of your heart, they’re called ventricular. When they begin in the atria, or upper chambers, they’re called supraventricular.

Doctors also group them by how they affect your resting heart rate. Bradycardia is a heart rate of fewer than 60 beats per minute. Tachycardia is more than 100 beats per minute.

Further Reading:

• WebMD – Arrhythmia