Rheumatic Heart Disease (RHD) develops as a complication of rheumatic fever, which itself is triggered by an infection with group A Streptococcus bacteria. Several risk factors increase the likelihood of developing rheumatic fever and subsequently RHD. These factors are particularly significant in areas with poor access to medical care or where there is a high prevalence of streptococcal infections. Here’s an overview of the risk factors for developing Rheumatic Heart Disease:

1. Untreated or Inadequately Treated Streptococcal Infections

  • Primary Cause: Rheumatic fever most commonly follows pharyngitis caused by group A Streptococcus. Failure to treat streptococcal sore throat or scarlet fever adequately with antibiotics increases the risk of developing rheumatic fever.

2. Genetic Predisposition

  • Influence: Certain genetic factors may predispose individuals to rheumatic fever after a streptococcal infection. Families with a history of RHD or rheumatic fever show higher susceptibility, indicating a potential genetic component.

3. Environmental Factors

  • Crowded Living Conditions: Overcrowding and poor living conditions can facilitate the spread of streptococcal infections, thereby increasing the risk of rheumatic fever.
  • Poor Sanitation: Inadequate sanitation also contributes to the higher incidence of streptococcal infections and subsequently rheumatic fever.

4. Socioeconomic Status

  • Impact: Lower socioeconomic status is associated with a higher risk of RHD, likely due to reduced access to healthcare, including delayed or insufficient treatment of streptococcal infections.

5. Geographical Regions

  • Prevalence: RHD is more common in developing countries, particularly in Sub-Saharan Africa, the Pacific Islands, parts of Asia, and indigenous populations in Australia and New Zealand. The higher prevalence in these regions is linked to poorer healthcare infrastructure and limited access to medical services.

6. Age

  • Typical Onset: Rheumatic fever most commonly affects children between the ages of 5 and 15, although it can occur at any age. The initial attack of rheumatic fever at these ages can lead to RHD later in life.

7. Gender

  • Observations: Some studies suggest a slightly higher incidence of rheumatic fever and RHD in females, but the data is not definitive.

8. Recurrent Episodes of Rheumatic Fever

  • Compounding Risk: Individuals who have had one episode of rheumatic fever are at a higher risk of recurrent episodes, particularly if not on long-term antibiotic prophylaxis. Each recurrent episode can cause additional damage to the heart valves, exacerbating the risk of developing or worsening RHD.

Prevention of RHD is largely focused on the prompt recognition and adequate antibiotic treatment of streptococcal throat infections to prevent rheumatic fever. For those who have already experienced rheumatic fever, long-term antibiotic prophylaxis is crucial to prevent recurrences, which is key to stopping the progression to RHD.

Last Update: June 3, 2024