Rheumatic Heart Disease

Would you ever think that a simple strep throat, if not treated properly, might cause serious cardiac complications and heart defects. One of them is rheumatic heart disease, which can be prevented and appears nowadays less and less. How to protect yourself and your loved ones, as well as avoid complications of this disease and about primary preventive treatments, you may read below.

Rheumatic heart disease (RHD) is the most common acquired heart disease in children across the world, especially in developing countries. The global burden of disease caused by rheumatic fever currently falls disproportionately on children living in the developing world, especially where poverty is a widespread issue.

RHD is a chronic heart condition caused by rheumatic fever that can be prevented and controlled. Rheumatic fever is caused by a preceding group A streptococcal (strep) infection. Treating strep throat with antibiotics can prevent rheumatic fever. Moreover, regular monthly injections of antibiotics can prevent patients with rheumatic fever from contracting further strep infections and causing progressive valve damage.

What are the concerns of rheumatic heart disease?

Acute rheumatic fever primarily affects joints, heart and central nervous system. The major concern of acute rheumatic fever is its ability to cause fibrosis of heart valves, leading to crippling valvular heart disease, heart failure and even death.

The overall decline of rheumatic fever in developed nations is believed to be the result of improved living conditions and availability of antibiotics for the treatment of group A streptococcal infection. In developing countries however, overcrowding, poor housing conditions, under nutrition and lack of access to healthcare play a role in the persistence of this disease.


Symptoms of heart valve problems, which are often the result of rheumatic heart disease, often include:

  • chest pain
  • excessive fatigue
  • heart palpitations (when the heart flutters or misses beats)
  • a thumping sensation in the chest
  • shortness of breath
  • swollen ankles, wrists or stomach.


Treatment for mitral valve stenosis depends largely on your symptoms and the severity of the condition. If you have no symptoms and only mild mitral valve stenosis, you might not require treatment at all.

Primary prevention of acute rheumatic fever (the prevention of initial attack) is achieved by treating the acute throat infections caused by group A streptococcus. This is achieved by up to 10 days of oral antibiotics (usually penicillin) or a single intramuscular penicillin injection.

People who have had a previous attack of rheumatic fever are at heightened risk of developing recurring attacks, which worsen the damage to the heart. Prevention of recurrent attacks of acute rheumatic fever is known as secondary prevention. This involves regular administration of antibiotics for many years. Secondary prevention programmes are currently thought to be more cost effective for prevention of RHD than primary prevention and are often the only feasible option for low- to middle-income countries.

Surgery is often necessary in repairing or replacing heart valves in patients with severely damaged valves, the cost of which is extremely high and is a drain on the limited health resources of poorer countries.


  • History taking and physical exam: To diagnose this condition, your doctor will ask about any recent strep infections (strep throat) or episodes of sore throats, examine your child and listen to their heart using a stethoscope. In children with rheumatic heart disease, doctors are often able to hear a heart murmur. During the exam, your child’s doctor will also look for any signs of inflammation in your child’s joints. Your doctor will ask for details about your child’s symptoms, their health history and your family’s health history.
  • Throat culture and Blood tests: Your doctor may order a throat culture or a blood test to check for any signs of strep throat or recent strep infection, as well as performing various other blood tests.
  • MRI (magnetic resonance imaging) of the heart:
  • Chest X-ray: X-ray images allow your doctor to see the condition of your lungs and heart. X-ray can also help in diagnosing conditions other than AF that may explain your signs and symptoms.
  • EchocardiogramThis non-invasive test uses sound waves to produce a video image of your heart. A wand-like device (transducer) that’s held on your chest (transthoracic echocardiogram) directs sound waves to your heart. To detect underlying structural heart disease, the sound waves provide video images of your heart in motion. A type of echocardiogram known as transoesophageal echocardiography may be performed in which they insert a flexible tube with a transducer attached and insert it down your throat into your oesophagus. Sound waves are used to produce images of your heart (seen more clearly with this type of echocardiogram). Doctors may also use this test to detect blood clots that may have formed in your heart.
  • Electrocardiogram: Small sensors (electrodes) are attached to your chest and arms to detect and record electrical signals as they travel through your heart. This is a primary tool for diagnosing AF.