Rheumatic Heart Disease: An In-Depth Review of Prevention, Pathophysiology, and Treatment Options
Author(s): Anastasia V. Poznyak*, Natalia Vladimirovna Elizova, Aleksandra Sergeevna Utkina, Elizaveta Romanovna Korchagina, Olga Nikolaevna Maltseva, Alexander N. Orekhov
Abstract
Rheumatic Heart Disease (RHD) is a major global health problem, particularly affecting populations in low- and middle-income countries. This disease results from an autoimmune response triggered by Group A Streptococcus (GAS) infection. The aim of this review is to thoroughly examine the complex pathophysiology of RHD, emphasizing the important role of molecular mimicry, which leads to autoimmune reactions, chronic inflammation of the heart valves, and subsequent long-term damage. Key etiologic factors contributing to RHD include inflammatory processes characterized by immune cell infiltration. This infiltration stimulates the production of proinflammatory cytokines, which further exacerbate inflammation and tissue damage. Furthermore, Matrix Metalloproteinases (MMPs) play a vital role in heart valve remodeling, exacerbating the structural degeneration associated with this disease. Genetics also plays a crucial role in the risk of developing RHD, as specific polymorphisms in the Human Leukocyte Antigen (HLA) system and other immune-related genes indicate increased susceptibility to this serious disease. Effective treatment for RHD is aimed at preventing Acute Rheumatic Fever (ARF) through timely administration of antibiotics. Furthermore, secondary prevention strategies are crucial for preventing relapses of ARF. Current treatment options include both drug therapy and surgical interventions aimed at resolving significant valvular dysfunction. Public health initiatives aimed at improving access to healthcare and educating the public about the risks associated with infections caused by GAV are crucial. Overall, this review highlights the need for integrated approaches combining clinical management with comprehensive preventive public health strategies to reduce the prevalence and consequences of RHD.