Dhaka, July 23 (News Network)-Sagar, a 25-year-old honors final year student of Sociology Department of Rajshahi University, often keeps indoor and avoids friends when they roam around the campus. He even skips important classes when he feels uncomfortable.

“My friends roam around the campus all day long, but I cannot because I have been suffering from rheumatic fever since my childhood’’ says Sagar with tears in his easy.

Sagar did not know about it until 2000 when a doctor, after seeing his X-ray report, had said that the left part of his heart got larger than the right one. He has remained untreated so long as his father could not afford the expensive treatment. “Now, eight years later, my life is at stake although I’m receiving treatment from my University clinic, but that is not enough’’ says Sagar.

According to available statistics, the prevalence of rheumatic disease is 4 per 1000 children in Bangladesh. It is rare under the age of 4 and becomes progressively less common after the age of 15.

Dr. Mustafa Zaman, an Assistant Professor of Cardiology at Bangabandhu Sheikh Mujib Medical University (BSMMU) and Fellow of Interventional Cardiologist of Max Heart and Vascular Institute, New Delhi, India, says it is not uncommon these days to see youngsters in the age group of 25-35 years getting into hospital with complaints of angina and in its severe form, acute heart attacks. “Even some young people succumb to sudden cardiac death even before reaching any sort of medical help’’ he says.

Rheumatic heart disease is a condition in which the heart valves are damaged by rheumatic fever. It begins with a strep throat from streptococcal infection. This fever is an inflammatory disease. It can affect many of one body's connective tissues, especially that of the heart, joints, brain or skin. Anyone can get acute rheumatic fever, but it usually occurs in children five to 15 years old. The rheumatic heart disease can last for life.

According to doctors, rheumatic fever leaks the joints but bites the heart. So, rheumatic heart   disease is a consequence of rheumatic fever, which leads to damage of the heart valves. Eventually, the damaged heart valves can cause serious, even disabling problems. These problems depend on how bad the damage is and which heart valve is affected. The most advanced condition is congestive heart failure. This is a heart disease in which the heart enlarges and cannot pump out all its blood.

Rheumatic fever is characterized by group A streptococcal (a form of bacteria) infection in early childhood that involves multi-systems in a child.

The World Heart Federation (WHF) focuses primarily on acquired disease, which develops sometime during childhood and includes diseases such as rheumatic heart disease, cardiomyopathy, bacterial endocarditis, pericarditis, Kawasaki disease, and Chagas disease.

Up to 1 percent of all schoolchildren in Africa, Asia, the Eastern Mediterranean region, and Latin America show signs of the disease. The worst affected areas are the Pacific island nations and Sub-Saharan Africa, where about 500,000 children are affected by rheumatic heart disease.

Affected children may need open heart surgery to repair or replace heart valves, which is costly for low and middle-income countries. But without surgery the quality of life is extremely poor. At the same time lack of awareness about treatment and resource shortages are barriers to the disease control in the developing world like Bangladesh.

The Symptoms of rheumatic heart disease vary greatly. Often the damage to heart valves is not immediately noticeable. A damaged heart valve either does not fully close or does not fully open.

Traditionally, heart disease has been divided into broad categories of congenital and acquired heart disease (AHD). Congenital heart disease (CHD) can present as simple structural heart defects like ASD and VSD (hole in the heart) or PDA (extra connection in the heart) or certain forms of complex structural defects which affect the newborns survival drastically like tetralogy of fallot (TOF) and transposition of great arteries (TGA) which lead to mixing of pure and impure blood in the heart.

Congenital defects can also affect the electrical conduction system of the heart (e.g congenital complete heart block), which may require a pacemaker to be put in a tiny heart for proper generation of electrical pulses. The reported incidence of CHD is 8-10/1000 live births, according to information released by World Heart Federation (WHF) and World Health Organization (WHO).

Acquired heart disease in the young is mainly of two types, Rheumatic fever / Rheumatic Heart Disease (RHD) and Coronary Artery disease (CAD).

Dr. Farida Adib Khanum, a physiology professor and the Principal of Eastern Medical College, says the disease is more common among the people of low socio-economic group. Overcrowding, damp environment, poor nutrition and sanitation may play an important role in causing rheumatic fever. All these environmental factors contribute to streptococcal infection and affect immunity.

There is no certain way of establishing the presence of rheumatic fever, but the combination of certain clinical features and laboratory finding is highly suggestive. The aim of the treatment of rheumatic fever is directed towards limiting cardiac damage, relieving symptoms and eliminating the streptococcal infection.

Physicians suggest absolute bed rest, adequate dose of aspirin, and long acting penicillin should be given in acute rheumatic fever. Bed rest must be continued until the indices for continuing disease activity have settled. Sometimes corticosteriod could be used if there is no response to aspirin or there is carditis.

Most importantly, the treatment should be to prevent the recurrence of the disease by giving regular prophylaxis against streptococcal infection preferably by injectable form of long acting penicillin.

Rheumatic fever, according to doctors, is a preventable disease and the primary preventive measures may decrease the morbidity and mortality caused by rheumatic heart disease.

- NewsNetwork