Rheumatic Heart Disease: Why It Can Happen in Children

Rheumatic heart disease (PJR), or in medical language, Rheumatic Heart Disease (RHD), is a heart disease as a result of the sequelae of Rheumatic Fever, which is characterized by the occurrence of heart valve defects. This disease is the most common cause of valve abnormalities, especially in children, so it can reduce productivity and quality of life. Based on statistical data in Indonesia, every year an average of 55 cases of RHD are found accompanied by rheumatic fever. It is estimated that the prevalence of RHD in Indonesia is 0.3–0.8 for schoolchildren aged 5–15 years.

Rheumatic fever is an inflammatory disease caused by a Group A Streptococcus Beta Hemolyticus infection in the upper respiratory tract, where the most common infection is tonsillopharyngitis. Symptoms of rheumatic fever usually appear 14–28 days after infection and can be in the form of prolonged fever, migrating joint pain, shortness of breath, symptoms of heart failure, reddish spots, lumps in joints or bones, and uncontrollable hand and foot movements. If rheumatic fever is not handled properly, complications can occur in the heart and develop into RHD. Symptoms of PJR include shortness of breath, chest pain, and a heart murmur that can be heard on examination with a stethoscope.

To make a diagnosis of RHD, it is necessary to do a physical examination, a heart recording (EKG), chest X-rays, and echocardiography (ultrasound of the heart). Echocardiography is the best examination to see if there is enlargement of the heart chambers, failure of the heart's pumping function, or blood clots in the heart.

Can PJR be prevented? You can. The method is to treat children who have Streptococcus Beta Hemolyticus Group A infections by administering the antibiotic Benzathine Penicillin G. When they have recovered, the administration of Benzathine Penicillin G is usually still given periodically every 3 weeks. The AHA (American Heart Association) recommends patients with rheumatic fever without heart symptoms receive prophylactic antibiotics for 5 years or until they are 21 years old, and if there are heart symptoms, antibiotics need to be given for 10 years or until they are 40 years old.

In simple terms, keep the house and environment clean, avoid children having recurrent cold coughs, and the most important thing is to bring children who have tonsillopharyngitis infections to seek treatment at health facilities to get optimal therapy so that the occurrence of PJR complications can be avoided.

Created by: Dr. Fitri Dwiyani, MARS

Reviewed by: Dr. Putria Rayani Apandi, Sp.A.K., M.Kes