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 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.
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 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.
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.
The following are the most common symptoms of rheumatic heart disease. However, each person may experience symptoms differently. Symptoms may include:
- 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 (belly)
- 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
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 over the heart. Echo can show damage to the valve flaps, backflow of blood through a leaky valve, 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.
How is rheumatic heart disease treated?
Specific treatment for rheumatic heart disease will be determined by your health care provider based on the following:
- The extent of the problem
- Your age, overall health, and medical history
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disorder
- The opinion of the health care providers involved in your care
- Your opinion and preference
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.
What are the complications of rheumatic heart disease?
Some complications of rheumatic heart disease include:
- 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 health care provider before getting pregnant.
- Ruptured heart valve. This is a medical emergency that must be treated with surgery to replace the heart valve.
Can rheumatic heart disease be prevented?
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.
Living with rheumatic heart disease
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.
When should I call my health care provider?
If your symptoms get worse or you have new symptoms, call your health care 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. The heart valve damage caused by rheumatic fever forces the heart to work harder to pump blood and, over time, may cause heart failure.
- 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 health care provider:
- 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 names of new medicines, treatments, or tests, and any new instructions your provider gives you.
- 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.