What is rheumatic heart disease?
Rheumatic heart disease is a condition in which the heart valves are damaged by rheumatic fever. Rheumatic fever begins with a strep throat from streptococcal infection.

Rheumatic fever is an inflammatory disease. It can affect many of the body’s connective tissues — especially those of the heart, joints, brain or skin. When rheumatic fever permanently damages the heart, the damage is called rheumatic heart disease.

Anyone can get acute rheumatic fever, but it usually occurs in children 5 to 15 years old. The rheumatic heart disease that results can last for life.

How can you tell if you have strep throat?
The most common symptoms of strep throat are the sudden onset of a sore throat (particularly with painful swallowing), fever, and tender, swollen glands under the jaw angle.

Laboratory tests can confirm inflammation and identify a streptococcal infection. There’s no specific lab test for rheumatic fever. Strep throat infections can be detected by throat cultures or more rapid laboratory antigen detection tests.

Throat cultures, blood antibody tests and other blood tests are also used to find out if a recent strep infection could have triggered rheumatic fever.




What happens in acute rheumatic fever?
The first symptoms are a high fever that lasts 10 to 14 days and arthritic pain and soreness that moves from one joint to another. In acute attacks of rheumatic fever, joints often swell and become red and hot.

A child suffering from rheumatic fever may have shortness of breath or chest pains. These symptoms indicate the heart is affected. Other signs include tiring easily, eating poorly or paleness. A doctor examining the child may hear an abnormal heart murmur or find that the heart is enlarged. Acute inflammation of the heart is a serious condition. It requires direct and some-times lengthy medical care.




What tests are used to detect heart damage?
Chest X-rays and an electrocardiogram are two common tests to find out if the heart has been affected.

Echocardiography sends sound waves into the chest to rebound from the heart’s walls and valves. The recorded waves show the shape, texture and movement of the valves. They also show the size of the heart chambers and how well they’re working. This technique doesn’t hurt or pose a risk to people.

Doctors also use cardiac catheterization to study heart damage.





What happens when rheumatic heart disease damages a heart valve?
A damaged heart valve either doesn’t fully close (insufficiency) or doesn’t fully open (stenosis).

A heart valve that doesn’t close properly lets blood leak back into the chamber from which it was pumped. This is called regurgitation or leakage. With the next heartbeat, regurgitated blood flows through the valve and mixes with blood that flows normally. This extra volume of blood puts more strain on the heart muscle. A doctor can diagnose an insufficient heart valve by listening to the heart and verify it by echocardiography.

When a valve doesn’t open enough, the heart must pump harder than normal to force
blood through the narrowed opening. Usually there are no symptoms until the valve opening becomes very narrow. With modern diagnostic tools, however, doctors can discover valves that can’t open fully many years before people complain of discomfort.

What are the symptoms of rheumatic heart disease?
Symptoms vary greatly. Often the damage to heart valves isn’t immediately noticeable. Some people have no problem or feel only mild discomfort for years.

Eventually, damaged heart valves can cause serious, even disabling, problems. These
problems depend on how bad the damage is and which heart valve is affected. Valve abnormalities on the heart’s left side (the mitral and aortic valves) usually cause symptoms earlier than abnormalities on the right side. The reason is that blood pressures are higher on the heart’s left side. (The tricuspid valve is usually the only valve affected by rheumatic heart disease on the right side of the heart. The pulmonic valve is almost never affected.)

People with mitral or aortic valves that don’t fully close find that their heart becomes overactive during vigorous work or play, or during emotional excitement. Increased physical or emotional activity puts more strain on a heart that’s already overworked because of the leaking valve.

As a result, the left ventricle gradually gets bigger to make up for the added volume of
blood. Eventually this becomes counterproductive, and the heart can’t pump enough blood. Pressure builds in the ventricle and causes blood to back up into the lungs, causing shortness of breath. It can result in an inadequate blood supply to the body and fatigue. The body also may retain fluid.

The lungs of people with mitral valve stenosis are under more pressure. This puts an extra burden on the heart’s right side, since it must pump against the raised pressure. The added pressure in the lungs also causes fluid retention (pulmonary edema) and shortness of breath.

In aortic valve stenosis, the extra pressure and larger size of the left ventricle means the heart muscle itself needs more blood. If the coronary arteries don’t supply enough blood to the heart tissue, angina pectoris can occur. Dizziness or fainting during exertion, shortness of breath, fatigue and palpitations are other symptoms of the same problem. The most advanced condition is congestive heart failure.

How can rheumatic heart disease be prevented?
The best defense against rheumatic heart disease is to prevent rheumatic fever from ever occurring. By treating strep throat with penicillin or other antibiotics, doctors can usually stop acute rheumatic fever from developing.

Often a doctor will wait for the result of a throat culture to be sure a strep infection is present and antibiotics are warranted. Most sore throats are caused by viral infections that aren’t helped by antibiotic treatment. Strep throats are bacterial infections, so antibiotics help them. People who’ve had rheumatic fever are at risk for more attacks and heart damage. That’s why they’re given continuous monthly or daily antibiotic treatment, maybe for life. If their heart has been damaged by rheumatic fever, they’re also given a different antibiotic when they undergo dental or surgical procedures. This helps prevent bacterial endocarditis, a dangerous infection of the heart’s lining or valves.

What can be done about a bad heart valve?
When heart valves are damaged by rheumatic fever, they may not open or close properly. If they don’t open properly, they block the forward flow of blood. If they don’t close properly, blood may leak backwards.

When these problems occur, valve replacement surgery may be recommended. In this surgery the diseased valve is replaced with a metal or plastic valve, or with a specially prepared valve from another human heart (cadaver valve) or from an animal such as a pig (porcine valve). Most people who have valve replacement surgery improve markedly.