Rheumatic Heart Disease

What is rheumatic heart disease?

Rheumatic heart disease is a
condition where 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. This can result in ongoing valve

What causes rheumatic heart disease?

Rheumatic heart disease is
caused by rheumatic fever. This is 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. This makes it harder for the heart to work normally.
This may take years to develop and can lead to heart failure. Rheumatic fever can
occur at any age. But it often occurs in children ages 5 to 15. It’s rare in
developed countries like the U.S.

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. They typically start 1 to 6 weeks after a bout of
strep throat. In some cases, the infection may have been too mild to be recognized.
Or it may be gone by the time the person sees a healthcare provider.

These are the most common
symptoms of rheumatic fever:

  • Fever
  • Swollen, tender, red and very
    painful joints (very often the knees and ankles)
  • Lumps under the skin
  • Red, raised, lattice-like rash,
    often on the chest, back, and belly
  • Shortness of breath and chest
  • 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 (very often
    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 health
history and physical exam, tests used to diagnose rheumatic heart disease may

  • 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 a handheld ultrasound probe (transducer) is
    passed over the skin over 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. For
    more in-depth pictures you may be given sedation and the probe is put into the
    throat (transesophageal echo or TEE).
  • Electrocardiogram (ECG). This
    test records the strength and timing of the heart’s electrical activity. It
    shows abnormal rhythms (arrhythmias or dysrhythmias). And it can sometimes find
    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
    exact look at the heart valves and heart muscle.
  • Blood tests. Certain blood tests
    may be used to look for infection and inflammation.