toys'
RHEUMATIC FEVER page
Of
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Vents
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Systems
excused him from gym class,
though he did join a softball game
occasionally. He couldn't keep up
well enough to play a game of
basketball, soccer or other run-
ning sports.
We finished sixth grade to-
gether but completed our educa-
tion at different schools. I never
saw him again. I would remem-
ber him in the 1950s while study-
ing acute rheumatic fever and
heart disease in medical school.
The condition usually starts
with strep throat. A reaction be-
tween the causative bacteria and
some people's immune system
triggers an inflammatory reac-
tion in the joints and the heart.
The joints usually recover fully,
but the heart may be perma-
nently affected. (Note: Rheuma-
toid arthritis is an entirely
different and unrelated medical
condition.)
After the acute inflammatory
phase cools down, the heart
seems to improve. Indeed, in
many patients the heart murmur
goes away in three to five years. .
For a significant percentage, the
heart valve or valves undergo a
gradually progressive scarring
process that causes either nar-
rowing or leakage, or both. Many
years later the heart murmur
may return, signaling serious
valve problems ahead. Any re-
currence of strep throat or acute
rheumatic fever can accelerate
the process.
My young friend probably did
very well through high school and
his 20s, but somewhere between
his 30th and 40th birthdays the
scarred heart valve or valves may
have deteriorated to the point of
needing heart valve surgery.
Once a patient manifests
symptoms and signs of acute
rheumatic fever, much can be
done to relieve the joint symp-
toms. For many, simple aspirin
therapy is all that's needed to
"cool the joints" and relieve the
pain. The cardiac aftermath of
acute rheumatic fever is closely
linked to the severity of the ini-
tial cardiac' involvement and to
any recurrence of rheumatic fever
in the future.
The incidence of these ailments
has markedly diminished in this
country since the late 1950s and
early 1960s. It was then that na-
tionwide programs of early peni-
cillin treatment for sore throats
and long-term penicillin prophy-
laxis for rheumatic fever victims
were promoted. Rheumatic fever
and rheumatic heart disease still
are common in those places in the
world where poor sanitation, lack
of modern medical attention and
lack of easy access to antibiotics
exist.
They taught us a pneumonic
in medical school about acute
rheumatic fever: "It licks the
joints and bites the heart." It's
nice to know that medical
progress has taken the bite out of
this condition. ❑
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