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Baby and childhood heart disorders: rheumatic heart disease BABY AND CHILDHOOD HEART DISORDERS: RHEUMATIC HEART DISEASE
Older children sometimes suffer from a disorder that affects their joints. But this is simply the tip of the ice-berg, for the condition usually subsides leaving little joint discomfort or pain. The long-term result can be a serious disorder of the heart. As one famous paediatrician says: 'rheumatic fever licks the joints but bites the heart'.
It is much less common than in times past and is more likely where housing difficulties occur; poverty, overcrowding and domestic difficulties seem to predispose to it.
It seems to attack children in the 5-15 year age group. It is rare before this and rare afterwards.
In acute cases, the child runs a fever and feels ill. Pain starts commonly in a large joint, such as the knee, ankle, elbow or wrist. It may become hot and swollen. After a few days the pain and swelling may leave that joint and spread to another one. Sometimes there is a rash. Occasionally, small swollen lumps appear over the elbows or wrists or at the base of the skull.
The heart is frequently involved. As the fever continues, the heart starts beating at a much faster rate than normally. Prompt medical attention is essential.
Some children, especially girls, may develop odd, irregular, muscular movements along with the joint pains. This is called chorea, or St Vitus's dance. Often the child becomes emotionally upset and unstable, fidgets and is clumsy in movements. Strange movements of the limbs and weird facial twitchings and face pulling occur. These are entirely out of the child's control. In mild cases, they may seem to be a bit like habit spasms, but in severe forms they can be marked and widespread.
Most cases of acute rheumatic fever are preceded by a simple throat infection by the germ called the beta-haemolytic streptococcus, and the strange joint symptoms may commence from one to three weeks later. The odd movements of chorea may start at any time from three to 15 weeks after the initial infection.
Sometimes acute attacks of rheumatic fever will continue in a silent manner, leading on to a condition called chronic rheumatic fever. This means the heart is definitely involved, and scarring of the heart muscle or the valves has taken place. The doctor usually finds special tell-tale signs that indicate this has occurred.
Treatment
Many doctors believe that prevention is better than cure, for many infected throats can herald this disorder. Prompt medical treatment by the doctor for sore throats in children may prevent onset of the disease, and parents should always be alert to complaints from their children. They should also make certain that medication prescribed is taken for the full course, and not merely for a few days until the throat seems a bit better.
Common sense in making certain the child has a good nutritious diet is essential. Making every effort to keep a reasonable standard of living will at least reduce the chances of contracting infections in the first place.
The doctor will work out a programme of treatment and it is essential it be followed. For acute cases, bed-rest, the salicylates, antibiotics and sometimes the steroid drugs are prescribed. A good diet is essential, and emotional back-up for the child always useful.
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