The polite and well-behaved ten-year-old girl, lying patiently in her school’s makeshift clinic in Cape Town, South Africa, is just like all of her friends – active and smiling. Also, like her friends, she is under strict instructions from her teachers to put âjokes in your pockets, smiles on your facesâ. But ultrasound waves bouncing from her heart during an echocardiogram show that she is different: she has congenital heart disease, which means her heart did not develop properly in the womb, and that makes each heartbeat less efficient.
This birth defect can lead to abnormal heart rhythms, shortness of breath, fatigue, and an increased risk of cardiovascular disease later in life. A child with the same heart disease in the UK is said to have received treatment as a baby and is closely watched throughout his life. However, although the girl had surgery to treat her heart defect, her parents were too worried about medical bills to bring her in for further follow-up. Without it, the operation she underwent did not fully resolve the problem with her heart. She is in desperate need of additional care.
This is just one of the hidden heart conditions spotted by a team of ten echocardiographs from around the world, during a five-day trip to Cape Town in September 2019. The group was a mix of cardiac physiologists, who use the echocardiography to diagnose heart patients, consulting physicians and university researchers. Our group came together as part of a humanitarian project to find hidden heart disease in South Africa, especially rheumatic heart disease.
This condition can be rare in most parts of the developed world, such as the United States and the United Kingdom. However, it is the leading cause of cardiac death in children and young people in developing countries. An estimated 250,000 people, most of them under 35, die from rheumatic heart disease worldwide each year. In South Africa, two in every 100 children are affected by the disease. But most have no idea they are affected, let alone receive treatment for the disease.
Rheumatic heart disease is an unfortunate side effect of rheumatic fever. Rheumatic fever is a rare complication that can develop after a bacterial infection of the throat, such as strep throat and scarlet fever, and causes inflammation of the heart, joints, skin, and brain.
The inflammation characteristic of rheumatic fever sometimes seeps into the heart, where it can damage heart valves, meaning some of the blood can flow through the valves in the wrong direction, rather than being pumped out. properly in the body. The disease can ultimately lead to disability due to heart failure and lead to the death of young patients.
Fortunately, this type of heart damage can be seen by trained eyes. Our team of echocardiographs – which are rare in South Africa – use portable echocardiographic machines to detect the disease. Caught quite early, the disease is easily treated with antibiotics.
We were trained by a Cape Town cardiologist, before going to three primary schools in the region where we provided free heart scans to over 1,000 children, ages 8 to 15.
At the first elementary school we visited, we found a boy with severe heart disease. Two of the cusps – the pieces of tissue that make up the heart valves – had fused, meaning her aortic valve is made up of two cusps, rather than the normal three. He had no idea he was living with this condition. While this disease is not rheumatic, this type of bicuspid heart valve could mean he could potentially develop breathing difficulties, chest pain, and fatigue later in life – and it could be life threatening, especially. in getting older. This child will now be closely watched and will have the surgery he needs if necessary.
The same day, we find the smiling girl who turns out to have a congenital heart defect that was “lost to follow-up” after her operation. We learn from Dr Luke Hunter, a Cardiologist in Cape Town who trained our group of volunteers, that this is a common problem as many families fear that medical bills could cripple their families. Finding out that this child needs additional medical follow-up could mean that she will live a longer, healthier life with follow-up.
The next day, we go to the less developed area of ââGrabouw and find the first confirmed case of rheumatic heart disease in another elementary school girl. The team is also finding a few other borderline cases of rheumatic heart disease, finding a total of 16 cases this week alone – plus one more case of congenital heart disease, bringing the total to three. All of these results are life changing for the children and families affected.
Our work found fewer cases of rheumatic heart disease in the region than in the previous year, which could mean that the disease is on the decline in the region. However, continued work in Cape Town will help continue to detect silent heart disease in the region, which is tragically shortening the lives of young people in Africa.