For several months, she experienced frequent shortness of breath and gasping, which eased with rest. She attributed this to her age and declining health. As symptoms worsened, she sought examination at a provincial hospital. There, she was diagnosed with aortic and mitral valve stenosis and transferred to Tam Anh General Hospital, TP HCM.

According to Master, Doctor, Second-Degree Specialist Huynh Hoang Khang, Head of Cardiovascular Surgery, Interventional Cardiology Center, the patient's two heart valves were severely narrowed and calcified. Heart valve stenosis occurs when the valve opening narrows, preventing proper opening. The valve leaflets may thicken, stiffen, or fuse, hindering full opening. The heart must pump harder to push blood through the narrowed valve, which over time leads to hypertrophy, heart failure, arrhythmias, and potentially death.

Initially, Ms. Nuong's symptoms were only transient fatigue and shortness of breath that resolved on their own, so she did not suspect heart disease. She only sought medical attention when her shortness of breath worsened, making her breathless after just a few steps, and her heart pounded rapidly. By then, the disease had progressed, causing significant atrial dilation and atrial fibrillation. Blood clots had formed in her left atrium, posing a risk of traveling to the brain and causing a stroke, or causing embolism anywhere else in the body.

Doctor Khang stated that multiple valve stenosis with calcification, as seen in Ms. Nuong, is a typical case of post-rheumatic heart valve disease. This condition involves heart valve damage resulting from the long-term effects of rheumatic heart disease, an autoimmune disease stemming from a group A beta-hemolytic streptococcal infection.

The disease often develops after episodes of pharyngitis or prolonged pharyngeal infections, lasting approximately 2-3 weeks. During this period, the body produces antibodies to combat the bacteria. Because the structure of certain components in the heart valves and heart muscle resembles that of the bacteria, these antibodies "mistakenly" attack the heart valves and muscle. This results in the thickening and fusing of the valve leaflets. Over time, calcium deposits cause the valve leaflets to calcify, harden, and reduce their ability to open and close flexibly, leading to heart valve stenosis or regurgitation.

Doctor Khang examines the patient before discharge. Photo: Ha Vu

The surgical team removed the two damaged valves, replaced them with bioprosthetic valves, and closed the left atrial appendage to reduce the risk of clot formation and embolization, thereby preventing stroke. Post-surgery, the artificial valves functioned well, the patient's heart rhythm stabilized, and her shortness of breath significantly improved. The patient recovered well and was discharged after 5 days.

Post-rheumatic heart valve disease often begins in adolescence with symptoms such as fever, pharyngitis, and joint pain. Children and adolescents infected with streptococcus who do not receive appropriate and sufficient antibiotic treatment are at high risk of developing rheumatic heart disease, which can then lead to heart valve disease sequelae. Even after the infection and fever subside, heart damage silently progresses. Many patients are only diagnosed with heart valve disease in adulthood, or even middle age, when symptoms become pronounced.

The most typical sign of post-rheumatic heart valve disease is progressively worsening shortness of breath over time, especially during strenuous activity, climbing stairs, or extensive exercise. Some cases also involve palpitations, rapid heartbeat, dizziness, and leg swelling. Children with post-rheumatic heart valve disease often tire quickly, have limited physical activity, and may experience delayed growth compared to their peers.

To prevent the disease, doctors recommend that individuals keep their bodies warm, maintain oral and pharyngeal hygiene, and limit the risk of upper respiratory tract infections. If symptoms like pharyngitis, fever, sore throat, or persistent cough occur, early medical examination is necessary. Antibiotic treatment should follow the correct protocol if the infection is streptococcal, ensuring full rheumatic fever prevention. Additionally, increasing physical activity and consuming a nutritious diet can boost immunity. Vaccination against infectious diseases such as: influenza, pneumonia, and rubella is also advised.

Individuals diagnosed with post-rheumatic heart valve disease should maintain a healthy lifestyle to slow disease progression. Patients should consume plenty of green vegetables, fresh fruits, and whole grains, prioritizing white meats like fish and chicken. They should limit saturated fats, fast food, and fried dishes. Regular exercise, sufficient sleep, and avoiding prolonged stress are also important. If symptoms such as increased shortness of breath, greater fatigue, leg swelling, palpitations, or chest pain occur, prompt follow-up appointments are crucial for treatment adjustment or timely intervention.

Thu Ha

* Patient's name has been changed