UAE cardiologist warns Arabs of Endocarditis threat

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.

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

"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.

"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".

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.

Dr Kallmayer added: "If treated early we can intervene through a combination of medication that relieves the burden on the heart, meaning the patient can go on for a much longer period of time without any interventions. Sometimes it can be treated surgically using minimal invasive techniques.

"Severe cases may have to undergo valve repair or replacement surgery, a life saving procedure.

The earlier the patient is examined, the more effective and less risky the intervention should be.

"Symptoms of advanced valve disease are often misinterpreted. I recently examined a 48 year old patient who was becoming increasingly short of breath and thought for months she had a severe bronchitis.

Further examination showed it was a lung congestion caused by Endocarditis weakening her heart.

"People should not be alarmed and rush to any self diagnosis. However, people in this age bracket, who grew up when medical care was scarce and had tonsillitis in their youth, which was not treated by antibiotics, should book in for a heart check up, which is quickly done. Anyone in this category, who has unexplained shortages of breath or have noticed their strength diminishing, should book immediately, with the tests taking less than an hour and the sophisticated machinery providing immediate results".