Rheumatic Heart Disease: Causes, Symptoms, Diagnosis, Prevention & Treatment
Rheumatic Heart Disease (RHD) is a serious and preventable cardiovascular condition resulting from rheumatic fever, which itself originates from a Group A Streptococcal (Strep A) throat infection. It primarily affects children and young adults, especially in developing nations, including India.
According to WHO, over 33 million people worldwide live with RHD, and it causes more than 300,000 deaths each year, mostly among low-resource populations. Lack of early detection and treatment of strep throat remains a major risk factor.
What is Rheumatic Heart Disease?
RHD is a long-term heart condition caused by permanent damage to heart valves following rheumatic fever. The immune system mistakenly attacks heart tissues while fighting strep bacteria, causing inflammation and scarring of:
• Mitral valve (most affected)
• Aortic valve
• Sometimes tricuspid or pulmonary valves
This leads to:
• Valve stenosis → narrowing & reduced blood flow
• Valve regurgitation → blood leaks backward
Over time, this can cause heart failure, arrhythmias, stroke, or endocarditis.
Causes of Rheumatic Heart Disease
The primary cause is untreated or poorly treated strep throat infection that progresses to rheumatic fever. Other contributing factors include:
Factor How it Increases Risk
Poor hygiene or sanitation Promotes bacterial spread
Overcrowding Faster transmission in children
Delayed antibiotic treatment Infection damages tissues
Repeated strep infections Increased valve damage
Weak immune response Heightens inflammation
Low access to healthcare Poor infection management
Most cases occur between ages 5–15, but RHD damage may appear later in adulthood.
Pathophysiology (How RHD Develops)
1. Strep Throat Infection (pharyngitis)
2. Immune system produces antibodies to fight bacteria
3. Antibodies cross-react with heart tissue (molecular mimicry)
4. Inflammation of heart — myocarditis, pericarditis, endocarditis
5. Scar formation on valves
6. Long-term valve dysfunction = Rheumatic Heart Disease
Signs & Symptoms of Rheumatic Heart Disease
Symptoms vary by severity and affected valve. Some individuals may remain asymptomatic for years.
Early Symptoms during Rheumatic Fever
• Severe sore throat
• Painful swollen joints
• High fever
• Skin rash
• Fatigue
• Jerky body movements (Sydenham chorea)
Cardiac Symptoms (RHD)
• Shortness of breath (worse during exertion or lying down)
• Chest pain or tightness
• Fatigue, weakness
• Frequent cough, especially at night
• Heart palpitations and arrhythmias
• Swelling in legs, feet, abdomen (edema)
• Fainting or dizziness
Complications
If left untreated, RHD may lead to:
• Congestive heart failure
• Stroke due to blood clots
• Pulmonary hypertension
• Infective endocarditis
• Pregnancy-related complications in women
Diagnosis of Rheumatic Heart Disease
• Early diagnosis is crucial to prevent irreversible damage.
1. Physical Examination
• Heart murmur detection with stethoscope
• Swelling, rapid heartbeat, shortness of breath
2. Laboratory Tests
Test Purpose
Throat culture / Rapid strep test Detect infection
ASO titer (Antistreptolysin O) Immune response to strep
ESR / CRP Inflammation markers
3. Diagnostic Imaging
Investigation What it Shows
Echocardiogram Valve narrowing, blood leakage, heart function
ECG Arrhythmias or heart enlargement
Chest X-ray Size of heart, lung fluid buildup
Doppler study Blood flow abnormalities
4. Jones Criteria for Rheumatic Fever
• Major criteria include:
• Carditis
• Polyarthritis
• Chorea
• Rash (erythema marginatum)
• Subcutaneous nodules
Treatment of Rheumatic Heart Disease
Treatment aims to: Manage inflammation
Prevent further strep infections
Repair heart valve function
Improve quality of life
• Medications
Type of Drugs Purpose
Antibiotics (Penicillin) Prevent recurrence of strep infection
Anti-inflammatory drugs (NSAIDs, corticosteroids) Reduce inflammation
Diuretics Treat heart failure symptoms
Beta-blockers / calcium channel blockers Manage arrhythmias
Anticoagulants (warfarin) Prevent clots, stroke risk
• Long-Term Secondary Prevention
• Monthly Penicillin injections for 5–10 years or until age 21+
• Regular cardiac monitoring
• Surgical & Interventional Options
When valve damage is severe:
• Balloon Valvotomy (minimally invasive)
• Valve repair
• Valve replacement
→ Mechanical or bioprosthetic valves
Patients with valve replacement require lifelong anticoagulation therapy.
Prevention of Rheumatic Heart Disease
Prevention is better and cheaper than treatment.
Primary Prevention
Stop infection from progressing to rheumatic fever:
• Treat strep throat with full antibiotic course
• Improve sanitation and clean water access
• Avoid overcrowded environments
• Improve public & school health services
Secondary Prevention
Avoid further heart damage:
• Long-term monthly antibiotics
• Regular echo check-ups
• Avoid smoking, alcohol, and heavy physical stress
Tertiary Prevention
Manage complications:
• Lifestyle modification
• Early surgical interventions when needed
Diet and Lifestyle Recommendations
• Eat heart-healthy foods: fruits, vegetables, whole grains
• Limit salt, fried & packaged foods
• Maintain healthy weight
• Moderate physical activity (based on doctor advice)
• Avoid tobacco and second-hand smoke
• Restrict caffeine if experiencing palpitations
Who is at Highest Risk?
High-Risk Groups Reason
School-aged children (5–15 years) Frequent infections
Low-income rural regions Limited healthcare
Overcrowded living conditions Fast bacterial spread
History of rheumatic fever Increased recurrence chance
Poor access to antibiotics Untreated infections
Prognosis
Early detection = Excellent prognosis
Late diagnosis with complications = High risk of heart failure, stroke & mortality
Regular medical follow-up improves life expectancy significantly.
FAQs About Rheumatic Heart Disease
1. Can adults get rheumatic heart disease?
Yes. Although infection usually occurs in childhood, symptoms may appear later in adulthood due to gradual valve damage.
2. Is RHD contagious?
No. Strep throat is contagious, but RHD is a non-infectious complication of untreated infection.
3. Can RHD be cured completely?
Valvular damage cannot be fully reversed once established — but medicines and surgery can manage symptoms and prevent worsening.
4. How long should antibiotics be continued?
Often monthly penicillin injections for 5–10 years or until age 21–40, depending on severity.
5. Can pregnancy worsen RHD?
Yes. Pregnancy increases cardiac workload, so women with RHD need specialized medical supervision.
5. Can vaccines prevent strep infection?
Currently no approved Strep A vaccine, but clinical research is ongoing.
Conclusion
Rheumatic Heart Disease is preventable, yet remains a major cause of disability and death — especially among young people in developing countries. Early and complete antibiotic treatment of strep throat and long-term preventive care are essential to stop progression to RHD.
If symptoms like persistent sore throat, fatigue, shortness of breath, or heart palpitations occur — seeking medical care immediately can save the heart from lifelong damage.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)