Rheumatic Heart Disease

What is rheumatic heart disease?

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.

What causes rheumatic heart disease?

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.

Who is at risk for rheumatic heart disease?

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.

What are the symptoms of 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:

  • 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
  • Weakness

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
  • Swelling

How is rheumatic heart disease diagnosed?

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.