Rheumatic Fever and the Heart

Infection plays an important part in initiating heart disorders in the young. Bacteria may first involve the tonsils, then the joints, and finally the heart. The “step” throat may be followed by an attack of so-called inflammation of the joints subsided with no permanent damage. The heart is damaged in about 60% of rheumatic patients. The injury may include all three layers of the heart, but most commonly there results in a condition known as rheumatic endocarditis. The infection causes the heart valves particularly the mitral valve to become inflamed. Small deposits of material form the blood produce vegetations, which form along the edges of the valves. The cusps thicken and tend to stick together, that is, to form adhesions. The valvular operating may become permanently narrowed as a consequence, and if, as is usually the case, the mitral valve is affected, the resulting adequate flow of blood from the left atrium to the left ventricle is forced to work much harder than usual in compensation, and eventually may fail. Recently operations to break adhesions have greatly lengthened the life expectancy of rheumatic fever cases.

When the infection subsided, and once inflamed valves begin to heal, the formation of the new tissue on the valve cusps may cause them to retract, so that they are unable to meet when the valve attempts to close itself. This causes a leakage of blood through the valve, and is known as incompetence of the valve.

Since rheumatic fever is most common between the age of 4 and 20 years of age, rheumatic heart disease is really a disease of youth. It is the most important cause of death between the ages of 10 and 14 years of age. In addition to this many are crippled for life, with the need of greatly limiting their physical activities. Prevention of serious respiratory illness and the removal of diseased tonsils will help prevent many cases of rheumatic heart disease.

2. Say which statements are false.

1) Infection plays an important part in initiating heart disorders.

2) Bacteria may first involve the lungs than the heart.

3) The injury may include all three layers of the heart.

4) The infection causes the aortic valve to become inflamed.

5) The right ventricle is forced to work much harder.

6) Recently operations to break adhesions have shortened the life expectancy of rheumatic patients.

7) Rheumatic heart disease is a disease of youth.

8) Adequate diet helps to prevent many cases of rheumatic heart disease.

3. Which information in the text you didn’t know?

4. Retell the text using the true statements.

Ex. 24. Read the text “Coronary artery disease” and ask as many questions as you can. Try to cover the main content of the text.

Coronary artery disease

Disease of the arteries that supply blood to the heart muscle.

Symptoms: There may be chest pain associated with exercise, which resolves when exercise is stopped. Shortness of breath may be associated. Pain may radiate down the left arm and to the jaw. This pain is called angina pectoris. More severe pain associated with nausea, vomiting, sweating and feeling faint are symptoms of “heart attack”. Pain of heart attack may be confused with pain of upset stomach or gas.

Cause: Deprivation of oxygen-carrying blood to the heart muscle because of the narrowing of the coronary arteries by plague formation on the wall. The plague contains cholesterol and cellular debris and may block the entire channel of flow. As a result, the deprived tissue creates the sensation of pain and may die.

Severity of Problem: Depends on the severity of blockage of the arteries, the suddenness of the problem and, in the setting of a heart attack, if ventricular fibrillation occurs. Chronic chest pain should be evaluated by a physician. If chest pain is severe, call the paramedics.

Treatment: In the case of chronic recurrent chest pain, the treatment involves diagnosis, diet, medication and prescribed exercise in a controlled setting. If good control is not possible surgery is considered.

In the setting of a heart attack, the treatment involves immediate hospitalization and administration of medicines for pain and to prevent ventricular fibrillation. If pain occurs after a heart attack, medical treatment and surgery are usually recommended.

Prevention: Diet low in cholesterol and saturated fats; no smoking; maintain weight within 10% of ideal weight; a routine exercise program; control of stress; periodic physical examination for early detection of problems.

Discussion: Coronary artery disease is a major killer in this country. Risk factors that strongly increase the likelihood of the coronary artery disease occurring are cigarette smoking, high blood pressure and diabetes. These should be controlled or avoided where possible. Coronary artery disease does run in families. In recent years dietary changes, exercise, early treatment and the training and use of paramedics have reduced the mortality from coronary artery disease.

Ex. 25.