Getting a new lease of married life

Dr KK Aggarwal

President Heart Care Foundation of India

New Delhi, February 6, 2018: Contrary to the popular belief that only men are prone to heart diseases, women are equally at risk. The irony of the situation is that something that has been passed down through generations never gets questioned and prevails. When women develop heart disease they are often a victim of delayed diagnosis and treatment. The Sameer Malik Heart Care Foundation Fund, an initiative of the Heart Care Foundation of India (HCFI), recently addressed one such case – that of a woman with rheumatic heart disease.

Raji (name changed) is getting married soon. Working as a maid in a house, 23-year-old Raji was suffering from rheumatic heart disease due to which two of her heart valves got damaged. She would become breathless on exertion and her echocardiogram suggested that both her left sided heart doors (valves) were leaking, putting pressure on the right side of her heart. This was when she contacted the Sameer Malik Heart Care Foundation Fund. Thanks to her employer and the HCFI, Raji got both the valves replaced at the National Heart Institute in September 2014.

In cases of rheumatic heart disease, the mean rate of progressive valve narrowing is approximately 0.1 cm2/year, if not operated in a timely manner. Progressive leaking of valves can lead to worsening of hemodynamic status and ultimately to clinical symptoms. Leaking begets leaking is the law. In principle, corrective surgery should be performed during the transition from a compensated to decompensated phase of the disease (that is, before the decompensated phase is established). Further damage to the valves can only be prevented through prevention of further attacks of sore throat called rheumatic sore throat. For this, the patient must be given injectable penicillin every 21 days till the age of 35.

However, timely treatment and sponsoring surgery are just the treatment part of this disease. The other angle to this also needs to be addressed – that of being able to lead a normal life, get married, and have children. For women, such issues can become a huge barrier to marriage. Most families will say no to a girl who has got two of her heart valves replaced. Not everyone may be as lucky as Raji to find a boy willing to marry despite all of it.

However, Raji is yet to cross another obstacle. With her condition, hemodynamic changes during pregnancy can result in cardiac decompensation. The management of pregnant women with prosthetic mechanical valves is complicated due to the increased risk of prosthetic valve thrombosis and thromboembolism related to the relative hypercoagulable state and difficulty managing anticoagulation during pregnancy. Women with older mechanical valves (ball-and-cage valves, single tilting disc), mechanical valves in the mitral valve position, multiple mechanical valves, arrhythmias, and those with a history of thromboembolic events are at higher risk of valve thrombosis than others.

Thus, helping her get a new heart valve is not the end of the picture. It remains to be seen how she is treated and accepted in the social environment. On our part, we wish Raji all the best for her life ahead and are proud of her grit and determination.