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Treat Recurring Sore Throat as a Red Flag

Early access to life-saving RF/RHD detection eases burden -- Cuyco
By Gynna Gagelonia/Francis Cortes

Rheumatic Fever/Rheumatic Heart Disease (RF/RHD) is still a pressing health issue in developing countries like the Philippines.

According to the World Health Organization, 1,807 Filipinos succumbed to the disease in 2020.  The age adjusted death rate is 1.81 per 100,000 population. The Philippines ranks #75 on the list of RF-RHD higher-burden countries in the world.

While RHD primarily targets children between 5 and 15 years old, it can hit individuals of all ages

RHD is a condition in which the heart valves have been permanently damaged by RF, an inflammatory disease that can affect many connective tissues, especially in the heart. Untreated or under-treated strep infections put a person at increased risk.

Treat sore throat or streptococcal infection that attacks repeatedly as a red flag. Don’t procrastinate your trip to the doctor. The inflammation can lead to a sort of immune mediated reaction that could travel to the heart.

“RHD is an inflammation of the heart due to recurring infections of the throat or the skin, leading to scarring of the valves that disrupts the heart's ability to pump blood efficiently. Aside from sore throat, the other symptoms are fever, swollen glands, fatigue, shortness of breath, and joint pains. The first step to diagnosis is to consult your doctor, so they can listen to your heart for any abnormal sounds called murmurs. After that, an X-ray and electrocardiogram may be performed, but the definitive test for RHD is a 2D echo with doppler studies", said  Dr. Ronald Cuyco, PHA president in a recent interview on PTV 4’s “Rise & Shine” morning show, hosted by Diane Querrer and Audrey Gorriceta.

From R PHA President Dr. Ronald Cuyco enlightens early bird viewers hosts Diane Querrer Audrey Gorriceta on Rheumatic Heart Disease

Increased awareness and getting access to RF-RHD subsidy  is key to aborting the streptococcal attack that will leave permanent damage to the valves of the heart.

Penicillin which is very affordable is pivotal in RF/RHD eradication.

 “Avail of the RF/RHD package  by checking out the list of hospitals that have a program that covers free 2-D echocardiographic screening, medication and penicillin. This is a joint undertaking between the Department of Health (DOH) and PhilHealth, in coordination with the PHA Council on RF/RHD,”  Cuyco, a cardiologist who subspecialized in echocardiography, announced.

Cuyco also  stressed that “even before there’s any damage to the heart, when someone has the symptoms, he/she needs to be treated with penicillin.  While penicillin is not cheap in the long run, it is very effective in preventing scarring of the heart valve. Even if there are already problems with the valve, penicillin is still given. Treatment can sometimes take 10 years or so. If medication is ultimately ineffective, surgery becomes the last option. This surgery can involve replacing the valve or, if the valve is narrowed, a transcatheter valvotomy is done to open it up”.

Transcatether valvotomy or valvuloplasty  is a minimally invasive structural heart disease treatment to open a narrowed heart valve with a catheter, a hollow, flexible tube.  Narrowing of heart valves can restrict blood flow and cause symptoms such as chest pain or shortness of breath.

It is easier to avert a problem than try to repair a problem. An ounce of prevention is worth than a pound of cure.

Prompt recognition, detection and action result in successful management because symptoms may also take decades to show, and by then it may already be late stages.

The PHA Council on RF/RHD, in collaboration with the Philippine  Foundation for the Prevention and Control of RF/RHD Foundation, Philippine Society of Pediatric Cardiology and the DOH sought the implementation of PhilHealth Outpatient Z-Benefit Package for Secondary Prevention of RF/RHD that will provide free Benzathine Penicillin injections and annual echocardiogram which took effect in 2019.  

Secondary prophylaxis for RF/RHD refers to the continuous antimicrobial prophylaxis to provide the most effective protection from recurrences of RF.

Meanwhile, an RF/RHD advocacy partnership  between the World Heart Federation and Philips Foundation kicked off in the Philippines in 2023.  Under the program, 6,000 children were  screened for RHD using the Philips innovative handheld point of care ultrasound device called POCUS; 190 Regional Health Units (RHUs) providing primary care  had healthcare workers trained on the RF/RHD clinical pathway;  and additionally, around 200 teachers were educated on RF/RHD  recognition; in Taguig Global City, Iloilo and Bicol.