With help from visiting specialists, LBJ doctors fight rheumatic heart disease

Locally: it is the largest cause of death due to heart failure in people under the age of 50

There is not a parent anywhere who has not struggled with serious decisions regarding their children’s health and well-being. None other than Benjamin Franklin told the story of losing one of his sons to smallpox in 1736.

From an essay written for the New York Times, Howard Markell, MD wrote of Franklin’s son, born in 1732 —  “a golden child, his smiles brighter, his babblings more telling and his tricks more magical than all the other infants in the colonies combined. Benjamin advertised for a tutor when the boy was only 2. When he died of smallpox at age 4, the Franklins were beyond condolence.”

Franklin later wrote that he regretted bitterly not allowing his son to be given an inoculation which was available to him. (Yes, in 1736, they were inoculating for smallpox) He meant the story as a cautionary tale to parents who omit care which they could have given children, thinking that their caution was correct.

“Showing that the regret may be the same, either way” he advised parents to choose the safer way — and give medicine a chance to prevent a dreaded illness. It was an instructional moment from one of America’s — indeed, one of history’s — greatest minds.

Fast forward to the year 2012, to the islands of the Pacific where another disease which affects little children is a serious — and preventable — problem: rheumatic fever, which can lead to life threatening heart disease.

It has been around for centuries, and has manifested itself worldwide, although extensive use of antibiotics have seen it beaten back in the U.S. and Europe, it still affects millions of children in Sub-Saharan Africa, south central Asia, and the Pacific, including certain populations in Australia and New Zealand.

Rheumatic fever is one of the complications associated with strep throat. The condition usually appears in children between the ages of 5 and 15, even though older children and adults have been known to contract the fever as well. By any account, it is a serious illness, and left untreated, it can cause stroke, permanent damage to the heart, and premature death.


According to LBJ pediatricians, over one-hundred and fifty children in American Samoa have had rheumatic fever in the past year, and due to poor compliance regarding their bicillin shots, many have developed rheumatic heart disease.

Working against time, the doctors of LBJ want to raise awareness of the disease, how to treat it, and how to prevent it from progressing to rheumatic heart disease.

According to Dr. Maria Gayapa, LBJ Vice Chief of Pediatrics, the reason it progresses to heart disease is due to the fact that children are not being brought back to the clinic for their shots. In other words, she says, this is a very preventable disease.

“We want parents to realize the importance of making sure their children get the medicine they need to prevent further problems” she emphasized.

LBJ pediatrician Beth Parker, M.D. explained further. “Rheumatic fever is caused by a strep throat infection that is not treated within nine days after it starts. Like any infection, our bodies have lines of defense to fight strep even without antibiotics. Unfortunately in rheumatic fever the antibodies, or infection fighters, get confused and attack the joints and the heart valves as well as attacking the strep bacteria.

 Many people present to their doctor with joint pain so severe that they can no longer walk. Others have unusual uncontrollable movements of their arms and legs. All of them have a recent history of a fever and of a strep infection.”

She continued, “When this happens, the doctor will order an EKG to look at the pattern of electrical conduction through the heart, a chest x-ray to evaluate the heart size, and some blood tests to confirm if there was a recent strep infection, and to see if there is still inflammation in the body. Several medicines may be prescribed to quiet down the inflammation and protect the heart. Most importantly, antibiotics are given to kill off the strep.”

Dr. Parker notes that the strep bacteria is so common in American Samoa that many people become infected over and over again.

“For that reason people who have had rheumatic fever must stay on antibiotics continuously to keep from getting strep infections again, because any time their body recognizes the strep it makes a lot of the antibodies which start to destroy the valves in the heart.”

LBJ pediatricians would like to advise the public: If you or someone that you know has ever had rheumatic fever, please follow up with a doctor to find out if bicillin antibiotic shots are needed. The antibiotics in this shot last for three weeks and will prevent the patient from catching strep bacteria during that time.

Any break in the antibiotic coverage shots leaves an opportunity for the strep to enter the body and cause further heart valve damage. According to the doctors, there are many people living in our community who have needed heart surgeries because of rheumatic heart disease, and it is the largest cause of death due to heart failure in people under the age of 50.


To further aid in the fight against rheumatic fever and associated heart problems, LBJ pediatrics is pleased to announce that a visit has been coordinated with the Oregon Health & Science University department of pediatric cardiology this week. Clinics are now being held from Tuesday November 13 until Monday November 19.

Two attending cardiologists, a cardiology fellow, a physician assistant, a nurse practitioner and two experts in cardiac ultrasound are expected to evaluate over 130 children with heart problems during this time.

The team will evaluate children with a wide variety of cardiac problems this week, some congenital and others acquired from infections, or from rheumatic heart disease. They will have a thorough history and physical performed and most will have an ultrasound of their heart which can show septal defects (holes in the heart), other malformations or damage to heart valves.  The team will then formulate a plan for management, advising on certain medications, or informing the parents if the child will eventually need surgery or other follow-up.

This follow-up is a very important part of caring for children with rheumatic heart disease because it lets parents know if the heart is being protected by the bicillin shots or if any other medications need to be added to protect the heart.

 The team will also advise patients if they will need surgery, and help to send information to cardiac surgeons in New Zealand and the United States if necessary.

LBJ Pediatric Department heads note: “We are delighted to welcome the team back to the island this November and hope that we can see them for many years to come.”

All of the OHSU team have volunteered their personal vacation time and will not be paid for their services here. They are also personally responsible for most of the travel expenses incurred in getting to American Samoa, which represents a very large financial and time commitment.

It should be noted that these costs were partially off-set by a generous $5,000 donation to the department of pediatrics by a fundraising event from Starkist.

 Unfortunately LBJ does not currently have funding to offer much financial support but the hospital will be donating breakfast and lunch on weekdays and also lodging for the team.

If you know that your child has a heart problem or rheumatic heart disease and you have not received a phone call to schedule an appointment, please contact the LBJ Pediatrics clinic at 633-1222.


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