Children more vulnerable to rheumatic heart disease

Published February 16, 2015
Khalid is being taken for further medical tests at the Aga Khan University Hospital. The teenager recently underwent a cardiac surgery and is recovering.—White Star
Khalid is being taken for further medical tests at the Aga Khan University Hospital. The teenager recently underwent a cardiac surgery and is recovering.—White Star

KARACHI: “I am feeling the difference and that is great. For the first time in two years, I am able to have a sound sleep. Earlier, the severe pain in my joints and back didn’t let me sleep,” said Khalid, a teenager who was recently discharged from the Aga Khan University Hospital, where he underwent a heart surgery.

A normal life has eluded Khalid, 17, the only brother of his four sisters, for seven years. Son of a wage earner in a remote village of Tando Mohammad Khan, Khalid continued to suffer from an unknown illness till a doctor in Hyderabad told him that he had a heart disease and needed to travel to Karachi for treatment.

“Initially, I got fever at the age of 10 while I was in eighth grade. My parents took me to different doctors that helped cure my fever but I later developed pain in the joints. At times, the pain used to get worse and I had difficulty in walking,” he explained, adding that that he had to leave school because of the illness.

Take a look: Children with heart disease fighting for life

Two years ago, Khalid came to Karachi with his uncle and was examined at two different health facilities. He was diagnosed to have rheumatic heart disease (RHD); a complication of rheumatic fever that usually occurs after attacks of rheumatic fever. The family, however, could not acquire medical treatment for him at any health facility due to financial constraints.

“At a major public sector cardiac hospital, we were told that the treatment would cost Rs170,000, if we opt for general admission or between Rs20,000 and Rs30,000 through a patient welfare scheme. But in order to avail the latter option, we have to wait for a year for treatment,” points out Haji, his uncle.

The family also visited the AKUH two years ago but left when they were told that the treatment would cost them Rs500,000. In recent weeks, they came across a resident of their village, also an AKUH employee, who guided them to seek medical treatment on a patient welfare programme.

Under the patient welfare programme, the hospital asked the family to deposit Rs150,000 of the total surgery cost that now has increased to Rs700,000. It was sheer luck that the family was able to receive help from a philanthropist who promised to bear the surgery cost.

The delay in treatment, though, had badly damaged Khalid’s two heart valves and the family was told that they were needed to be replaced with artificial ones. The double valve replacement surgery was conducted on Feb 9.

“We have replaced the aortic and mitral valves that are of an adequate size for Khalid since he has grown up. However, in case of young children small artificial valves are replaced with bigger ones at a later stage,” said Dr Muneer Amanullah, the cardiac surgeon who led the operation.

The teenager, according to him, would have a cent per cent normal life after three to four months. “The function of his heart is not good at the moment. But that would improve gradually and there wouldn’t any activity restriction on him after some period.”

Explaining the RHD, he said that it was one of the most serious forms of heart disease of childhood and adolescence and was caused by rheumatic fever that could be prevented and controlled. The fever usually started out as a step throat (streptococcal) infection.

“Though it can affect adults, children are more vulnerable because of their low immunity levels. When the body reacts to the infection, antibodies develop that damage the heart. The disease usually shows up after five years following infection,” he said, adding that often patients reported at hospitals when the disease had reached an advanced stage.

Dr Amanullah underlined the need for awareness on the disease among medical professionals as well as parents, who should consult a cardiologist once the patient was diagnosed with a heart problem.

Regarding the disease prevalence in Pakistan, he said no study had been conducted on it, though rough estimates suggested that 50,000 to 100,000 people with RHD might be present in the country. At the AKUH, he said, three to four surgeries involving RHD were conducted every week.

Sharing her experience, Dr Najma Patel, a senior cardiac surgeon at the National Institute of Cardiovascular Diseases said that 15 to 20 RHD patients were weekly admitted into the hospital.

“The number of newly registered patients at the out-patient department per week is around 40. Most patients come from remote areas across the country,” she said.

According to Dr Patel, the new international health guidelines suggest that all sore throats infections should either be treated with penicillin or any other antibiotics that is effective against the streptococcal bacterium that causes rheumatic fever.

Published in Dawn, February 16th, 2015

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