Rheumatic Heart Disease

What is rheumatic heart disease?

Rheumatic heart disease is heart valve damage from rheumatic fever. Bacterial infections called group A streptococcal (GAS) infections can cause rheumatic fever. An infection like strep throat or scarlet fever triggers your body’s immune response, causing inflammation throughout your body, including in your heart.

Inflammation from rheumatic fever can lead to permanent damage to your heart valves. Your valves keep your blood flowing in the right direction through your heart. Damaged valves reduce the amount of blood that can move through your heart. They also may allow some blood to go in the wrong direction.

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 where people can’t get antibiotics for bacterial infections. About 300,000 people worldwide die of rheumatic heart disease each year. More than 40 million people in the world have the disease.

Children and teenagers with untreated strep infections are the most likely to get rheumatic fever, often between ages 5 and 15. Signs of heart damage can develop years after the infection and fever are gone. People often show signs of rheumatic heart disease as young adults.

What are the symptoms of rheumatic heart disease?

Some people may have symptoms of heart involvement during an acute episode of rheumatic fever. But in most cases, rheumatic heart disease symptoms 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 with exercise, at rest or when lying flat.
• Swelling in your stomach, hands or feet.
• Palpitations or cardiac arrhythmias like atrial fibrillation.
• Coughing up blood.

What causes rheumatic heart disease?

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

Is rheumatic heart disease contagious?

Rheumatic heart disease isn’t contagious. But strep throat is. This infection can lead to rheumatic fever, the cause of rheumatic heart disease.

What are the risk factors 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 unsanitary conditions.

What are the complications of rheumatic heart disease?

Rheumatic fever can affect your heart about 20 or 30 years after an episode of rheumatic fever. If you had repeated episodes or were younger when you had rheumatic fever, you may see the consequences of rheumatic heart disease at a younger age.

One or more of your heart valves can grow narrow (referred to as stenosis of the valve) or allow blood to flow backward in the wrong direction. Providers call this regurgitation. Rheumatic heart disease tends to affect the mitral and aortic heart valves.

Rheumatic heart disease can lead to:

• Arrhythmia (abnormal heart rhythms, like atrial fibrillation).
• Heart failure.
• Infective endocarditis, an infection in your heart valves.
• Pulmonary hypertension.

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

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. As a result, a person with damaged heart valves can have serious health issues during pregnancy. The fetus’s health is also at risk.

How is rheumatic heart disease diagnosed?

To diagnose rheumatic heart disease, a healthcare provider will evaluate your symptoms and perform a physical exam. They’ll also review your health history, especially any history of fevers or bacterial infections.

What tests will be done to diagnose rheumatic heart disease?

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

• Blood tests to check for inflammation or a high immune response.
• Chest X-ray to check for signs of heart failure.
• Echocardiogram (an ultrasound of your heart) to find leaky or narrowed heart valves.
• Electrocardiogram (EKG, a test of your heart’s electrical activity) to check for abnormal rhythms.

How is rheumatic heart disease treated?

Rheumatic heart disease treatments can help you manage symptoms and may delay disease progress. But they can’t cure the condition. Treatments include:

• Medication: Your provider may recommend medication to manage heart failure or an abnormal heartbeat. Anticoagulants (blood thinners) can reduce the risk of stroke or blood clots if you have a narrow mitral valve or atrial fibrillation.
• Minimally invasive procedure: If your mitral valve is narrow but you don’t have other issues with it, a provider can perform a valvuloplasty to widen the valve.
• Surgery: If you have severe rheumatic heart disease, you may need heart valve surgery. A surgeon repairs or replaces damaged heart valves. If they can’t fix your valve, they can replace the damaged valve with an artificial valve or a tissue valve. In some cases, they may perform a Ross procedure, where a surgeon swaps one of your healthy valves for the damaged valve and then puts a new valve in place of the healthy one they relocated.

Can rheumatic heart disease be prevented?

Yes. 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:

• Fever.
• Joint pain.
• Muscle pain.
• Sore throat.
• Tonsilitis (swollen tonsils).
• Chorea (jerky, uncontrollable movements of the head, arms or legs).
• Nodules or a rash on the skin.

People at risk of rheumatic heart disease may need penicillin injections every three to four weeks for five or more years or lifelong, depending on the degree of heart involvement. This can also keep rheumatic heart disease from getting worse by preventing the infection that causes rheumatic fever.

What can I expect if I have rheumatic heart disease?

The right treatments may delay or prevent heart failure in people with rheumatic heart disease. But the disease is permanent and requires long-term care. Without regular checkups, rheumatic heart disease can lead to severe heart failure.

The length of time that you can live with rheumatic heart disease depends on how severe it is at diagnosis. In a study of indigenous people in Australia under 25, those who had severe rheumatic heart disease at diagnosis got worse fairly quickly. Of this group, 50% had surgery within two years and 10% of them died within six years after their diagnosis.

Some people with moderate disease improved, while others stayed the same or got worse. Ten years after diagnosis, 60% of people with mild rheumatic heart disease didn’t get worse.

How do I take care of myself?

If you have rheumatic heart disease, you should avoid getting rheumatic fever again. It can make your heart disease worse. Your provider can monitor your health to make sure you get antibiotics if you get strep throat again. You may also be able to receive antibiotics to prevent the strep infection that causes rheumatic fever.

Follow your provider’s instructions for treating rheumatic heart disease. That may include taking medicines, going to follow-up appointments or having surgery.

When should I see my healthcare provider?

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

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

What questions should I ask my healthcare provider?

Questions to ask your healthcare provider may include:

• How severe is my case of rheumatic heart disease?
• Did the disease affect one or more of my heart valves?
• Which treatment is best for me?
• Do I need antibiotics to prevent further episodes of rheumatic fever?

A note from Cleveland Clinic

Maybe you couldn’t do anything about the strep infections you had as a child. But you can do something now about rheumatic heart disease. Take charge of your health by talking with a healthcare provider about the best ways to treat your heart issue and stay safe from another infection. The best thing you can do for your health is to follow a provider’s advice for staying healthy.