Rheumatic Heart Disease (RHD) is diagnosed through a combination of medical history, physical examination, and specific diagnostic tests that assess the presence and severity of valve damage typically caused by rheumatic fever. Here’s how the diagnosis process usually unfolds:
1. Medical History and Physical Examination
- Medical History: The doctor will inquire about any history of rheumatic fever, which is the primary cause of RHD. Details about recent sore throat infections or untreated streptococcal infections, as well as family history of RHD, are also considered.
- Physical Exam: During the physical examination, the doctor listens for heart murmurs, which are often a key indicator of valve problems. They will also look for signs of heart failure, such as swelling in the legs, and symptoms of atrial fibrillation.
- Primary Diagnostic Tool: An echocardiogram uses sound waves to create detailed images of the heart. It is the most effective tool for diagnosing RHD because it can visualize the structure and function of the heart valves and chambers, showing abnormalities in valve movement, thickening, or regurgitation (blood leaking backward through the valve).
- Types: Both transthoracic (non-invasive, done from the chest wall) and transesophageal (more invasive, done from inside the esophagus) echocardiograms might be used depending on the clarity of images needed.
- Purpose: While blood tests cannot diagnose RHD directly, they are useful for indicating inflammation or a past infection with streptococcus. Elevated levels of streptococcal antibodies, such as anti-streptolysin O (ASO) titers, can support a history of rheumatic fever.
- Usage: An ECG, which records the electrical activity of the heart, is often performed to check for arrhythmias like atrial fibrillation, which can be associated with RHD.
- Additional Imaging: A chest X-ray can show changes in the size and shape of the heart and signs of heart failure, such as fluid in or around the lungs.
- Advanced Imaging: In certain cases, a Cardiac MRI (Magnetic Resonance Imaging) might be used to provide more detailed images of the heart’s structure and function, especially if the echocardiogram results are inconclusive.
- Flow Assessment: This test measures the speed and direction of blood flow through the heart’s chambers and valves, helping to assess the severity of any regurgitation or stenosis in valves.
The diagnosis of RHD often relies on the detection of cumulative heart damage over time, necessitating regular monitoring and follow-up, especially for those with a history of rheumatic fever. Early detection and ongoing management are crucial to prevent progression and mitigate symptoms effectively.