Rheumatic Heart Disease

What is rheumatic heart disease?

Rheumatic heart disease is heart valve damage resulting from rheumatic fever. Bacterial infections called group A streptococcal (GAS) infections can cause rheumatic fever. An infection, such as strep throat or scarlet fever, triggers your body’s immune response. It causes inflammation throughout the body, including in the heart. If untreated, the inflammation can lead to permanent heart valve damage and serious health problems.

Who gets rheumatic heart disease?

Children and teenagers with untreated strep infections are the most likely to get rheumatic fever. Signs of heart damage can develop years after the infection and fever are gone.

How common is rheumatic heart disease?

Rheumatic heart disease is rare in the U.S. It’s more common in low-income or developing parts of the world. Antibiotics for bacterial infections may not be available in these areas. About 300,000 people worldwide die of rheumatic heart disease each year.

Who is at risk for rheumatic heart disease?

People are at a higher risk for this disease if they:

• Don’t have easy access to healthcare or antibiotics.
• Have repeated strep infections that go untreated.
• Live in overcrowded or unhealthy conditions.

What are the symptoms of rheumatic heart disease?

Symptoms of rheumatic heart disease may not appear until years after a strep infection or rheumatic fever. People with heart damage may experience:

• Chest pain.
• Fatigue.
• Heart murmur.
• Shortness of breath.
• Swelling in the stomach, hands or feet.

What causes rheumatic heart disease?

Heart valve inflammation from rheumatic fever causes rheumatic heart disease. The damage may occur right away. Or it can develop over time from repeated strep infections. Continuing inflammation leads to heart valve scarring and narrowing.

The disease tends to affect the mitral and aortic heart valves. These valves control blood flow. If the valves don’t work, blood leaks backward into the heart instead of flowing out of the heart.

How is rheumatic heart disease diagnosed?

Your healthcare provider:

• Evaluates your symptoms.
• Performs a physical exam.
• Reviews your health history, especially any history of fevers or bacterial infections.

Your provider may use the following tests to diagnose heart valve disease:

• Blood tests to check for inflammation or a high immune response.
• Echocardiogram (an ultrasound of the heart) to find leaky or narrowed heart valves.
• Electrocardiogram (test of the heart’s electrical activity) to check the heartbeat.

How is rheumatic heart disease treated?

There’s no cure for rheumatic heart disease. Treatment can help you manage symptoms and may delay disease progress. Treatments include:

• Medication: Your provider may recommend medication to manage an abnormal heartbeat. Anticoagulants (blood thinners) can reduce the risk of stroke or blood clots.
• Surgery: Severe rheumatic heart disease may need heart valve surgery. A surgeon repairs or replaces damaged heart valves.

How is heart valve repair performed?

During heart valve repair surgery (also called balloon valvuloplasty), your surgeon:

• Inserts a catheter (thin, flexible tube) into a small incision (cut) in your leg or chest.
• Funnels a deflated balloon through the catheter to your damaged heart valve.
• Inflates the balloon inside the valve, opening it to help improve blood flow.

How is heart valve replacement performed?

If it’s not possible to perform a repair, you may need valve replacement surgery. Your surgeon replaces the damaged valve with an artificial valve or a tissue valve. In some cases, your surgeon may perform a Ross procedure. The procedure swaps one of your healthy valves for the damaged valve.

How can I prevent rheumatic heart disease?

You can prevent rheumatic heart disease by taking antibiotics at the first signs of a streptococcal infection. See your healthcare provider if you or your child has:

• Chorea (jerky, uncontrollable muscles movements).
• Fever.
• Joint pain.
• Muscle pain.
• Sore throat.
• Tonsilitis (swollen tonsils).

What is the outlook for people who have rheumatic heart disease?

People with well-managed rheumatic heart disease can enjoy a high quality of life. The right treatments may delay or prevent heart failure. But the disease is permanent and requires long-term care.

What are the complications of rheumatic heart disease?

Rheumatic heart disease can lead to:

• Arrhythmia (abnormal heartbeat).
• Atrial fibrillation (abnormal heartbeat in the upper parts of the heart that prevent normal blood flow).
• Heart failure (heart doesn’t pump blood as well as it should).

Any of these conditions can increase your risk of stroke or blood clots.

How does rheumatic heart disease affect pregnant people?

Rheumatic heart disease is especially dangerous for pregnant people. Pregnancy increases the amount of blood in your body. Your heart has to work harder to pump the extra blood. A person with damaged heart valves can have serious health issues during pregnancy. The fetus's health is also at risk.

When should I call the doctor?

Contact your healthcare provider if you experience new or worsened symptoms, including:

• Confusion.
• Difficulty breathing.
• Chest pain.
• Swelling or pain in your lower body.

A note from Cleveland Clinic

Rheumatic heart disease is the result of inflammation in the heart. The inflammation is your body’s immune response to an untreated bacterial infection. Over time, it damages your heart valves and disrupts blood flow. Rheumatic heart disease can lead to heart failure. People with the condition need careful monitoring and treatment.