Re: Rheumatic mitral regurgitation. Is healing possible?

Posted By Muruga on April 30, 1999 at 10:50:22
My son who is six years old was diagnosed with rheumatic fever with moderate mitral regurtitation about one year ago. He is on vasotec now because his heart enlarged at 6 month follow up. I heard from his pediatrician that one of his friend had rheumatic fever with heart problems at age 14 and murmur disappeared after 26 years. My son's cardiologist said that 70% of folks with my son's stage of the disease may be free of disease in ten years. But when I got a second opinion from another cardiologist, he says the disappearance of the murmur is unlikely and he may need valve repair sometime. I would like to know your opinion and from people who have/had rheumatic heart disease.

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on April 30, 1999 at 16:15:35

Dear Muruga,
Thank you for your question.  Rheumatic fever (RF) can be either acute or chronic.  Acute rheumatic fever is due to an unusual reaction to strep throat.  It occurs in about 0.3 % of patients with sore throat in which beta-hemolytic group A streptococci grow in throat cultures.  The age range is usually 3 to 15 years old and is rare before the age of 2 or after 25.  The symptoms include a relapsing fever, a migratory arthritis that usually involves the large joints of the lower extremities, a rash on the trunk of the body, subcutaneous nodules and a type of movement disorder called Sydenham's chorea.  Potential cardiac involvement includes electrocardiographic changes and valvular damage.
The diagnosis of rheumatic fever is based on clinical finding and the presence of strep antibodies.   Treatment for acute rheumatic fever is with high dose aspirin and antibiotics. Due to the potential for recurrence following acute rheumatic fever careful follow-up is indicated and antibiotic prophylaxis is recommended for adolescents and young adults.
Chronic rheumatic fever, also called relapsing rheumatic fever, is a prolonged syndrome of recurring fevers and requires life-long antibiotics.  The majority of people with acute RF do not go on to develop chronic RF but a percentage do.  
The other factor with RF is the potential for heart damage.  The most common damage is mitral and aortic valve stenosis (narrowing).  The diagnosis of valve narrowing is made on physical exam (murmur) and with echocardiogram. If damage to a heart valve occurs it is permanent and often progressive.  Some people will require valve replacement when they are older while others will be OK with medication alone.
Rheumatic fever can be prevented by treating strep infections with antibiotics.  This is why doctors will often check throat cultures in children with sore throats.  Due to the wide use of antibiotics RF has been nearly eliminated in the West.  It is still common in developing countries.
Does you son have acute or chronic RF?  Has he had an echo?
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.











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