One of the UAE's leading heart doctors has spoken out about an alarming number of local patients showing late symptoms of rheumatic endocarditis, an inflammation of the heart attracted in childhood leading to scarring and subsequent shrinking of the valves.

The dangerous condition, which is now rarely seen in Europe and America, usually remains undetected until in advanced stages. However, it is common among Arabs and South Asians as young as 40 or 50, who may not have been provided adequate medical care in their youth.

Rheumatic valve disease often occurs in middle age as a result of juveniles suffering from the common throat condition of acute tonsillitis not being treated with antibiotics. As a result, countries with medical systems established generations ago have all but eradicated instances of the condition.

But countries such as the UAE, that have only developed its medical system in the past few decades, have citizens presenting with the disease. Rheumatic endocarditis is in fact rampant throughout the Middle East and South Asia.

“I am seeing an astonishing number of patients presenting with valve disease in our clinic, as many as 10 each week,” said Dr Klaus Kallmayer of German Heart Centre in Dubai Healthcare City (DHCC).

"I had never seen such high numbers before I arrived in Dubai two years ago. However, valve disease caused by Rheumatic Fever really is a ticking time bomb as it can be very well tolerated by the heart for decades. However, when symptoms arise, they escalate very quickly.

"Virtually everyone has had acute tonsillitis at some point during growing up. If not treated with antibiotics such as penicillin, often rheumatic fever develops and a certain percentage of people will acquire heart or kidney disease,” added Dr Kallmayer.
 
"The simple fact is that 40 years ago the UAE and most of the Middle East had very limited medical facilities and hospital provisions, so many as young as 40 or 50 have never been examined or treated for conditions such as tonsillitis. It is for the same reasons that many Indians, Pakistanis and other Asians may also be at risk of endocarditis.

"It is only in the past 20 years that there have been great leaps in medicine here. But, the damage was done and I have now examined many local Arabs who were not aware they had serious valve disease. Not even people born in this region within the last 25 years can be secure in the knowledge that they have been treated properly.

"The heart is an organ that can compensate for a great deal of stress. But, once any strain has been too great for too long, the heart will suddenly become very weak and symptoms begin. Even 40 years after a seemingly harmless throat infection," said Dr Kallmayer.

It is for these reasons that it is important for those potentially at risk to be checked out in order to establish if any problems exist before symptoms show. The easy first step is to have an experienced cardiologist or family physician listen to heart sounds and murmurs. If these are conspicuous, Echocardiography and Colour Flow Doppler technology show shape, function of and flow across the valves.

Valves are the mechanical devices that allow only forward flow of blood to the heart, while preventing backward flow. A valve becomes thickened through Endocarditis, which will gradually restrict its movement: It may not open properly, similar to a calcified tap, and when this happens, the blood backs up and the pressure rises upstream, while the flow on the other side of the vale diminishes.

Alternatively the valve can shrink, and when this happens it becomes incompetent and the blood will also flow backwards. The consequences of this are the same and the blood backs up burdening the heart with an increasing load. The heart can sustain this for years, but not for ever. When it becomes weak it is a rapid spiral and vitally important to detect early.