Overview
Rheumatic heart disease is lasting damage to the heart valves, caused by rheumatic fever.
Rheumatic fever is a complication of a throat infection, or sometimes a skin infection, caused by group A streptococcus (strep) bacteria. The bacteria do not attack the heart directly. Instead, the body's defences, while fighting the infection, mistakenly attack healthy tissue, including the joints and the heart valves. Repeated attacks can scar the valves.
It mostly affects children and teenagers, and is most common where families live in poverty and crowded housing and have little access to health care, including parts of south Asia.
Symptoms
Rheumatic fever usually starts one to five weeks after a throat infection. Symptoms can include:
- A high temperature
- Painful, swollen joints, often the knees, ankles, elbows or wrists, and the pain may move from joint to joint
- Chest pain, breathlessness and a fast heartbeat
- Jerky, uncontrollable movements of the hands, feet or face
- Small lumps under the skin, or pink patches on the arms and tummy
Rheumatic heart disease may cause no symptoms for years. Later it can cause tiredness, breathlessness, chest discomfort, swollen feet or tummy, and a racing or irregular heartbeat.
When to see a doctor
See a doctor soon if a person who has had rheumatic fever gets a sore throat, or if fever, painful swollen joints or jerky movements follow a sore throat. People with known rheumatic heart disease should be seen for new tiredness, breathlessness, swollen ankles or a racing heartbeat.
Causes
Rheumatic fever follows an infection with strep bacteria, usually in the throat. Most people with a strep infection never develop it. Doctors do not know exactly why some do, though genes may play a part.
Each attack can inflame and scar the heart valves. Over time they may become narrowed, leaky or both.
Risk factors
- Strep throat that is not treated, or that keeps coming back
- A previous attack of rheumatic fever, which can return, especially in younger people
- Childhood and the teenage years
- Poverty, crowded housing and poor access to health care
Complications
Damaged valves make the heart work harder and can lead to:
- Heart failure
- An irregular heartbeat, including
- Blood clots and stroke
- Infection of the heart valves (endocarditis)
In pregnancy, the extra blood the heart must pump puts more strain on damaged valves. Many women first learn that they have rheumatic heart disease when they are pregnant.
Prevention
Rheumatic heart disease can be prevented in two ways:
- Treating strep throat promptly with , which prevents rheumatic fever from starting
- For anyone who has had rheumatic fever, regular injections of long-acting penicillin, often for many years, to stop it coming back
Better housing and easier access to health care lower the risk across a whole community.
Diagnosis
There is no single test for rheumatic fever. Doctors use a set of agreed signs (the Jones criteria) and look for evidence of a recent strep infection, such as a throat swab. Rheumatic heart disease is found with an , an scan of the heart that shows the valves and how well they work. The scan also helps decide how often check-ups are needed and how long penicillin should continue.
Treatment
Rheumatic fever is treated with , pain relief, steroids if the pain is severe, medicines for jerky movements, and rest. Most people recover from the illness itself within about three months, though it can take longer.
Valve damage cannot be reversed, and there is no cure. Long-term penicillin prevents more damage. Medicines can treat heart failure and rhythm problems, and blood-thinning medicines may be used to lower the risk of clots. Severely damaged valves may need surgery to repair or replace them. Regular check-ups and scans continue for years.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A sore throat is minor. It will go away by itself, so there is no need to see a doctor.”What is true?
Fact
Most people with a throat infection never get rheumatic fever, but some do, and the damage to the heart is permanent. Prompt antibiotic treatment of strep throat prevents rheumatic fever, so a child's sore throat should be seen by a doctor who can decide what is needed.
Myth“Once the fever and joint pain are gone, the child is cured.”What is true?
Fact
The fever and joint pain settle, and most people recover from the illness itself. But rheumatic fever can leave lasting damage to the heart valves, and the damage may take years to appear. Anyone who has had it needs regular check-ups and heart scans.
Myth“The penicillin injections can stop once the child feels well.”What is true?
Fact
The injections stop the throat infection from coming back, which would bring more fever and more valve damage. They are usually needed for many years, and the doctor decides how long, depending on how much the heart is affected. Stopping early puts the heart at risk.
Myth“Damaged heart valves cannot be helped.”What is true?
Fact
The damage is permanent and there is no cure, but treatment helps a great deal. Penicillin prevents further damage, medicines treat heart failure and rhythm problems, and severely damaged valves can be repaired or replaced by surgery.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Can rheumatic fever happen again?
Yes. A previous attack makes another more likely, especially in younger people, and each attack can add to the heart damage. That is why a sore throat in someone who has had rheumatic fever should be seen by a doctor promptly, and why long-term antibiotics are given.
Why are penicillin injections given for so long?
The injections protect against repeat strep infections, which can bring back rheumatic fever and harm the valves further. A long-acting form is given into a muscle every few weeks. The doctor decides how long to continue, depending on how much the heart is affected.
Does rheumatic heart disease spread from person to person?
No. The strep throat infection that can trigger rheumatic fever does spread from person to person, like other throat infections. Rheumatic fever and the heart damage that follows do not spread. Genes may make some people more likely to develop it.
Can a woman with rheumatic heart disease have a safe pregnancy?
Pregnancy puts extra strain on damaged valves, which raises the risk of rhythm problems and heart failure. A woman with rheumatic heart disease should see a heart specialist before she becomes pregnant, or as early as possible in pregnancy, so that her care can be planned.
