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A Deceptive Disease in Disguise – Suhasini S, MBBS PDF Print E-mail
A young girl sitting silently in one of the beds caught my attention as I entered the medical wards of the Government Hospital in Coimbatore, India.

Before I could utter a word, an anxious looking lady came running, looked at me and after a while said “My daughter has no problems with her joints, we have come here for her chest pain” and she was perplexed with the fact that the doctors attending her daughter were questioning on joint pain and not bothered about her chest pain.
Shanti's mother seldom realized that the joint pain and swelling was a gateway to her daughter's heart disease. Shanti had acute joint pain when she was 13 and this I gathered from her case history. It took me a few minutes to gather that the girl probably suffered from a “Rheumatic heart disease”

This fact is unknown to many in our country. Infact, the very idea of join pain causing heart problems is in conceivable.

Rheumatic Heart Disease affects children (being most common between 5 and 15 years) or young adults. This disease has become rare in countries like Western Europe and North America. Nevertheless, it remains endemic in parts of Asia, Africa and South America with an annual incidence in some countries of more than 100 per 100000, it is still the most common cause of acquired heart disease in childhood and adolescence.

The condition is triggered by an abnormal response to infection with specific micro organisms like streptococci that possess antigens which cross react with the heart muscle. Our body tries to protect against these micro-organisms by synthesizing antibodies which kiss the organisms. These antibodies lick the joints and bite the heart.

Clinical Features:-

Rheumatic fever is a multi system disorder

It produces

a) Sore throat
b) Fever
c) Loss of weight
d) Loss of appetite
e) Joint pains
f) Neurological manifestation
g) Skin lashes
h) Affects the heart

Mostly it manifests with joint pain and fever during young age.

- It affects the heart, its incidence declined with increasing age ranging from 90% at 3 years to around 30% in adolescence.

- Joint involvement is painful where the knee joints are commonly involved. The joints are red and swollen.

- Red patches spear on the skin. It is the right time to take the child to the doctor and take a complete treatment. The medicines prescribed by the doctor should be taken accordingly and should not be discontinued as soon as the sore throat and fever subsides, as it may affect the heart which you may not know.

If this disease is left untreated during its episode it may produce severe heart disease at the later part of life.

So a child suffering with (5-15 years) joint pain, fever sore throat ->Take to the hospital -> Doctor makes few investigations -> Treatment with
a) Antibiotics
b) Bed rest, supportive therapy
c) Pain killers
d) Steroids

If this disease is left untreated it will affect the valves of the heart in later part of life.

Let me explain you what are valves. The heart is made of chambers. These chambers have blood in them and in between the chambers are small doors which are the valves which controls the flow of blood from one chamber to the other.

The function of heart is to supply blood to all parts of the body. So due to this infection that occurs during young age, the valves are affected. A few years later this would cause obstruction to the flow of blood and produces major heart problems. This could be treated surgically only by valve replacements.

So now I think you will be able to understand that due to carelessness of Shanti's mother who had ignored her joint pain which occurred at 13 years of age, Shanti suffers a major heart disease now.

Now the treatment requires a lot of money and by this valve replacement surgery it improves only her quality of life and not the quantity. Let us be aware and be alert enough not let the enemies enter our heart and capture them in the very beginning.

Have a healthy life!
 

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Date: Jun 03, 2009


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