Rheumatic fever leads to rheumatic heart disease. Rheumatic fever is common in children age 5 to 15 years. It can also occur at any age. Heart disease due to rheumatic fever is a condition in which rheumatic fever damages the heart valves permanently. The process of heart damage begins shortly after strep throat or scarlet fever infections. Streptococcal bacteria cause these infections. Our body’s immune system responses against these infections – due to which an ongoing inflammatory condition develops in the body leading to progressive heart valve damage.

Rheumatic heart disease pathophysiology

Rheumatic fever is an inflammatory disease as it affects connective tissues in the joints, skin, brain and the heart. It causes inflammation of the heart – especially heart valves – which may progressively lead to scarring over a period of time. The damaged caused to heart valves make them narrow and leaky and results in abnormal functioning of heart valves. Rheumatic fever develops in children and adolescents after streptococcal infections of the pharynx initiate an autoimmune reaction. Acute rheumatic heart disease often leads to pancarditis – characterized by pericarditis, endocarditis and myocarditis. Mitral valve is most commonly affected followed by the aortic valve. The pulmonary valve is rarely affected. In the acute phase of rheumatic disease, severe valve insufficiency may lead to congestive heart failure and even death.

Symptoms of rheumatic fever

The Symptoms of rheumatic fever begins after two to five weeks of strep throat. The symptoms vary from person to person. In some cases, the symptoms are too mild to be recognised – and sometimes go early. While diagnosis rheumatic disease, a cardiologist may ask the patient about the recent medical history of strep throat infection. It is key to the diagnosis of the disease.

The typical signs and symptoms of rheumatic fever include fever, painful joints; severe joint pain in some areas, swollen, tender, red and painful knees and ankles; rash on the back or chest and abdomen; weakness; chest discomfort and shortness of breath and muscle spasms.

Symptoms of Rheumatic Heart Disease

The symptoms associated with heart disease depends on the degree of heart valve damage. The symptoms may not be noticed for years. Chest pain, shortness of breath when lying down and with physical activity, tiredness and weakness and swelling of the legs are some of the common symptoms, if the disease is severe.

Rheumatic heart disease risks

The main cause of rheumatic fever that leads to heart disease is strep throat infections. The risk increases manifolds if strep throat infections are not treated in time. In addition, the risk increases tremendously in children and adults who get recurrent strep throat infections – as these infections may lead to rheumatic fever and heart disease.

Rheumatic heart disease diagnosis

A cardiologist examines the patient thoroughly. After a complete physical examination and taking a medical history, the cardiologist orders a few tests including blood tests, ECG, echocardiogram, chest X-ray and cardiac MRI to diagnose rheumatic disease caused by rheumatic fever.


Untreated heart disease can lead to arrhythmias (abnormal heart rhythms), endocarditis and increases the risk of brain stroke. It also increases complications during pregnancy. Heart disease associated with rheumatic fever can lead to premature death in young adults.

Rheumatic heart disease treatment

The treatment for rheumatic heart disease depends on the extent of damage caused to the heart and the associated symptoms, age and health status of the patient. Medical therapy includes antibiotics for treating infection of the heart valves. If the damage caused to the heart valves is severe, the heart valve repair or replacement procedures will be recommended by the cardiologist. Treatment always depends on the severity of heart disease.

Prevention of rheumatic disease

To prevent heart disease and its complications, do take the following measures:

  • Do Prompt antibiotic treatment of sore throats
  • Take a full course of appropriate antibiotics if you get rheumatic fever
  • Maintain good dental hygiene
  • Go for Regular health check with a cardiologist
  • Take Good prenatal care during pregnancy
  • Adopt Holistic management of throat infections
  • Focus on a healthy lifestyle

Bottom Line

Remember this always – Untreated or under-treated strep infections put a person at increased risk of life-threatening heart disease. Henceforth don’t take strep throat and other streptococcal infections lightly. If you maintain good oral hygiene – you can prevent heart disease as well.