Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. The heart valve damage starts with an untreated or under-treated strep infection. In some cases, strep throat or scarlet fever, which are caused by streptococcus A bacteria, can progress to rheumatic fever if not treated properly.
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 valve damage caused by rheumatic fever forces the heart to work harder to pump blood and, over time, may cause heart failure. Heart-related symptoms may take years to develop.
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.
The following are the most common symptoms of rheumatic heart disease. However, each person may experience symptoms differently. Symptoms may include:
Symptoms of rheumatic heart disease depend on the degree of valve damage and may include:
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:
Specific treatment for rheumatic heart disease will be determined by your health care provider based on the following:
Treatment depends in large part on how much damage has been done to the heart valves. In severe cases, treatment may include surgery to replace or repair a badly damaged valve.
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 medications 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 future attacks of rheumatic fever and lower the risk of further heart damage. To reduce inflammation, aspirin, steroids, or non-steroidal medications may be given.
Some complications of rheumatic heart disease include:
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 health care provider to check the condition of your heart. Depending on the amount of heart damage, you may have some activity restrictions. Your health care 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 health care provider.
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