Silent threat: A sore throat could lead to rheumatic heart disease

Rheumatic heart disease (RHD) may sound rare, but it is one of the most common causes of heart problems in young people across Africa. It remains a largely preventable but devastating condition that silently affects thousands, especially in low- and middle-income countries.

Elijah Ogola, a clinical cardiologist, explains it as damage to the heart valves. "It develops after rheumatic fever, which itself arises from a throat infection by a bacteria called streptococcus," Prof Ogola.

The body's defence system fights the infection but also harms its own tissues, especially the valves that keep blood flowing in the right direction.

RHD does not appear overnight. The damage often begins in childhood but only shows up years later.

"The mitral valve is usually the first to be affected," says Peter Ogutu, a cardiac surgeon at Aga Khan University Hospital. "Over time, patients experience shortness of breath, palpitations, chest pain, dizziness and fatigue."

These signs are often mistaken for asthma, anaemia or ordinary tiredness. A sore throat that keeps recurring, especially in children, should never be ignored. Adults should seek care if they struggle with simple activities like climbing stairs.

The tragedy of RHD is that it is highly preventable. A single course of the right antibiotics can treat a streptococcal throat infection and stop rheumatic fever from developing.

Children who have had rheumatic fever are usually placed on monthly penicillin injections to prevent reinfection and further damage.

When caught early, lifestyle changes and regular follow-ups can slow the disease but once valves are scarred, surgery becomes the main option.

"If the valve is mildly affected, balloon procedures can buy time," Dr Ogutu says. "For advanced disease, we repair or replace the valve."

Replacement valves can be mechanical, which last longer but require lifelong blood thinners to prevent clots, or tissue-based, made from animal tissue which wear out sooner but avoid complications from medication. Women of childbearing age need special attention, as pregnancy places extra strain on the heart.

Untreated RHD can lead to heart failure, stroke, irregular heartbeat and even sudden death. In Kenya, many patients are diagnosed late, when surgery is the only hope. ''This is a disease we can prevent, diagnose and treat locally," says Ogutu

The disease thrives in poor settings where overcrowding, limited access to antibiotics and lack of awareness allow untreated infections to linger. The World Health Organization (WHO) estimates that 40 million people worldwide live with RHD, with Africa carrying nearly half of the deaths.

Unlike lifestyle-related heart problems, RHD begins with something as small as a sore throat. It mainly affects young people in their teens and twenties, cutting lives short at their most productive stage.

"This is a disease we can prevent, diagnose and treat locally," says Dr Ogutu. "There is no need for patients to seek help abroad."

Public health experts continue to call for awareness drives, school-based screening and better access to antibiotics.