Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever. An immune response causes an inflammatory condition in the body which can result in on-going valve damage.
Rheumatic heart disease is caused by rheumatic fever, an inflammatory disease that can affect many connective tissues, especially in the heart, joints, skin, or brain. The heart valves can be inflamed and become scarred over time. This can result in narrowing or leaking of the heart valve making it harder for the heart to function normally. This may take years to develop and can result in heart failure.
Rheumatic fever can occur at any age, but usually occurs in children ages 5 to 15 years old. It’s rare in developed countries like the United States.
Untreated or under-treated strep infections can increase the risk for rheumatic heart disease. Children who get repeated strep throat infections are at the most risk for rheumatic fever and rheumatic heart disease.
A recent history of strep infection or rheumatic fever is key to the diagnosis of rheumatic heart disease. Symptoms of rheumatic fever vary and typically begin 1 to 6 weeks after a bout of strep throat. In some cases, the infection may have been too mild to have been recognized, or it may be gone by the time the person sees a doctor.
These are the most common symptoms of rheumatic fever:
- Swollen, tender, red and extremely painful joints — particularly the knees and ankles
- Nodules (lumps under the skin)
- Red, raised, lattice-like rash, usually on the chest, back, and abdomen
- Shortness of breath and chest discomfort
- Uncontrolled movements of arms, legs, or facial muscles
Symptoms of rheumatic heart disease depend on the degree of valve damage and may include:
- Shortness of breath (especially with activity or when lying down)
- Chest pain
People with rheumatic heart disease will have or recently had a strep infection. A throat culture or blood test may be used to check for strep.
They may have a murmur or rub that may be heard during a routine physical exam. The murmur is caused by the blood leaking around the damages valve. The rub is caused when the inflamed heart tissues move or rub against each other.
Along with a complete medical history and physical exam, tests used to diagnose rheumatic heart disease may include:
- Echocardiogram (echo). This test uses sound waves to check the heart's chambers and valves. The echo sound waves create a picture on a screen as an ultrasound transducer is passed over the skin overlying the heart. Echo can show damage to the valve flaps, backflow of blood through a leaky valve, fluid around the heart, and heart enlargement. It’s the most useful test for diagnosing heart valve problems.
- Electrocardiogram (ECG). This test records the strength and timing of the electrical activity of the heart. It shows abnormal rhythms (arrhythmias or dysrhythmias) and can sometimes detect heart muscle damage. Small sensors are taped to your skin to pick up the electrical activity.
- Chest X-ray. An X-ray may be done to check your lungs and see if your heart is enlarged.
- Cardiac MRI. This is an imaging test that takes detailed pictures of the heart. It may be used to get a more precise look at the heart valves and heart muscle.
- Blood tests. Certain blood tests may be used to look for infection and inflammation.
The best treatment is to prevent rheumatic fever. Antibiotics can usually treat strep infections and keep rheumatic fever from developing. Anti-inflammatory drugs may be used to reduce inflammation and lower the risk of heart damage. Other medicines may be needed to manage heart failure.
People who have had rheumatic fever are often given daily or monthly antibiotic treatments, possibly for life, to prevent recurrent infections and lower the risk of further heart damage. To reduce inflammation, aspirin, steroids, or non-steroidal medicines may be given.
Some complications of rheumatic heart disease include:
- Heart failure. This can occur from either a severely narrowed or leaking heart valve.
- Bacterial endocarditis. This is an infection of the inner lining of the heart, and may occur when rheumatic fever has damaged the heart valves.
- Complications of pregnancy and delivery due to heart damage. Women with rheumatic heart disease should discuss their condition with their healthcare provider before getting pregnant.
- Ruptured heart valve. This is a medical emergency that must be treated with surgery to replace or repair the heart valve.
Rheumatic heart disease can be prevented by preventing strep infections or treating them with antibiotics when they do occur. It’s important to take antibiotics as prescribed and to complete them as instructed, even if you feel better after a few days.
You will need to have ongoing follow-up with your healthcare provider to check the condition of your heart. Depending on the amount of heart damage, you may have some activity restrictions. Your healthcare provider may recommend that you take antibiotics for an extended period to prevent another infection of rheumatic fever.
If your symptoms get worse or you have new symptoms, call your healthcare provider.
- Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever.
- Rheumatic fever is 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. Children who get repeated strep throat infections are at the most risk for rheumatic fever and rheumatic heart disease.
- A recent history of strep infection or rheumatic fever is key to the diagnosis of rheumatic heart disease. Symptoms of rheumatic fever vary and typically begin 1 to 6 weeks after a bout of strep throat.
- People with rheumatic heart disease may have a murmur or rub that may be heard during a routine physical exam.
- Treatment depends on how much damage has been done to the heart valves. It may even include surgery to replace or repair a badly damaged valve.
- Since rheumatic fever is the cause of rheumatic heart disease, the best treatment is to prevent rheumatic fever by using antibiotics to treat strep infections.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
January 16, 2018
Gerber, MA. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Stretococcal Pharyngitis. Circulation (2009); 116, Natural history, screening, and management of rheumatic heart disease, Up To Date, Acute rheumatic fever: Treatment and prevention, Up To Date, Acute rheumatic fever: Clinical manifestations and diagnosis, Up To Dae
Kang, Steven, MD,Fetterman, Anne, RN, BSN