Rheumatic Heart Disease: Everything You Need to Know

Published August 3rd, 2021 by Chris Riley
Fact Checked by
Erik Rivera
Medically Reviewed:
Dr. Angel Rivera

Rheumatic heart disease, or RHD, is a condition that causes inflammation of the lining of the heart and can lead to death if left untreated. The rheumatic fever bacteria, streptococcus A, attacks soft tissue in the body which leads to rheumatic heart disease. This inflammation from rheumatoid fever to the heart, which usually happens during childhood, is called rheumatic valvulitis, and this can affect both the aortic valve and mitral valve causing them to harden. Learn more about rheumatic heart disease including signs and symptoms, diagnosis and treatment methods, as well as prevention tips so you are better informed on how to keep your loved ones safe from this serious illness.

What is rheumatic heart disease?

Rheumatic heart disease is a condition where the valves in the heart are damaged and cannot move as much blood through the heart as needed. It can cause inflammation of the heart muscle, rheumatism, swelling of one leg or arm, and rheumatoid arthritis. Rheumatic heart disease is caused by an immune response from becoming ill with rheumatic fever, a condition caused by streptococcal bacteria which is found in throats or mouths commonly known as strep throat. 

What causes rheumatic heart disease?

There are many things that can cause rheumatic fever, such as streptococcus bacteria and other types of infections, both viral and bacterial, but often it is unknown what exactly triggers the onset of rheumatic fever in an individual person. The most common trigger for the development of rheumatic fever appears to be infection with Group A beta-hemolytic streptococci bacteria, which include Streptococcus pyogenes bacterium, a pathogen known to cause a wide array of infections including strep throat and scarlet fever. This type is found in throat and mouth areas and will enter into open wounds on skin easily if not covered up properly before contact occurs. Sometimes people who have rheumatic fever do not know how they contracted it, and it can be passed on to others through close contact.

Who is at risk for rheumatic heart disease?

Most people can get rheumatic fever if they come in contact with rheumatic bacteria, but some people are more likely to get rheumatic fever than others. These are people who have had previous rheumatic fever or rheumatic heart disease, people living in certain parts of the world such as Asia and Africa that have poor farming conditions, and children from ages 5-15 years old. Adults living closer to the equator like in India and Australia also seem to be more at risk for getting rheumatic fever. If left untreated or not treated thoroughly with antibiotics, rheumatic fever can increase the risk for rheumatic heart disease.  

What are the symptoms of rheumatic heart disease?

The symptoms of rheumatic heart disease have some overlapping symptoms of rheumatic fever which include: 

  • swelling in one leg or arm that is painful and stiff 
  • painful joints in your hands or feet caused by acute rheumatic fever
  • fever which usually lasts two weeks but sometimes a month long if left untreated 
  • weakness
  • uncontrolled movements of the arms, legs, or facial muscles
  • chest pain accompanied by shortness of breath
  • a rash, usually on the chest, back, or stomach
  • heart murmur with an irregular heartbeat that, in severe cases, can even lead to heart failure

This last symptom needs treatment right away because it will restart again when you wake up from sleep, so don't just go back to bed. If your child develops any of these signs, take your child to their doctor or a medical professional as soon as possible.

How do you diagnose rheumatic heart disease?

For the diagnosis of rheumatic heart disease, a rheumatologist will need to do an echocardiogram which is an ultrasound of the heart that can detect any problems with your valves and even measure how well they are functioning in pumping blood through the body. Sometimes this test may show changes in blood pressure or lighter than normal heart sounds so if you have these symptoms then it's important for you to see a rheumatologist about potential rheumatic fever treatment options. Remember, the longer you wait to treat RHD the more likely you are to cause permanent damage to your heart. 

There is also another type of testing called M-mode sound measurement that shows on screen different movements inside your chest when breathing like lung size expansion and muscle strength. Sometimes rheumatic fever can be detected with this test, but not always so it's important to get your echocardiogram too, and make sure everything is okay.

How do you treat rheumatic heart disease?

The treatment for rheumatic heart disease includes: 

  • antibiotics which are given intravenously (IV) or as a pill depending on the severity of your symptoms 
  • steroids to help reduce inflammation in the heart valve tissues that have been damaged by rheumatic fever 
  • pain relievers such as acetaminophen, found in Tylenol, or ibuprofen, found in Advil, if you're experiencing pain from arthritis among other things due to rheumatic fever-like swelling in one leg or arm, joint pain in hands or feet, or fever
  • valve replacement surgery may be used in severe cases 

There are also rheumatic fever treatments for children and adults which can include more steroids depending on the severity of symptoms. There's a special type called corticosteroids that are given to treat rheumatic heart disease inflammation in the heart valve tissues caused by rheumatoid arthritis-like pain from swollen joints in hands or feet; throat infection, like tonsillitis; rash due to streptococcal bacteria found inside your throat or mouth area; headache, fatigue, muscle soreness, fever, and joint pain. Please talk to your doctor about which specific treatments are right for you. 

Are there side effects from rheumatic fever treatments?

There can be side effects from rheumatic fever treatments that include: 

  • severe allergic reactions to antibiotics or steroids which will irritate your skin and lead to red bumps all over the body called hives depending on what type of medication you're taking at the moment
  • high blood pressure due to too much water retention in tissues that occurs with steroid use

This last side effect is more common if someone has a history of high blood pressure but it's important not to take any medications without consulting your rheumatologist first as they may have other options for treating rheumatic heart disease inflammation, like low dose aspirin therapy or an ACE inhibitor drugs such as lisinopril, losartan, or ramipril.

How can you prevent rheumatic heart disease?

There's not a lot you can do about preventing rheumatic heart disease. However, it is important for people with rheumatoid arthritis to take care of their joints by doing exercises like stretching your muscles every day and getting plenty of rest so they don't become inflamed. 

The most important thing you can do to prevent rheumatic heart disease is to see a doctor when you have symptoms of a strep infection or rheumatic fever. If you are diagnosed with a strep infection or rheumatic fever by your physician, take the prescribed antibiotics for as long as instructed and do not stop taking them because you feel better after a few days. Doing this will help to ensure that you beat the infection so that it does turn into rheumatic heart disease. 

Summary

We have discussed rheumatic heart disease and its diagnosis, treatment, and what you can do to prevent it. Rheumatic fever is a type of bacterial infection often caused by strep infections or rheumatic fever. RHD is an inflammatory condition that occurs in people who have rheumatoid arthritis or other types of rheumatological diseases. If you believe you or your child has rheumatic fever or a strep infection, please see your healthcare provider right away to help prevent rheumatic heart disease and to determine the best treatment options for you today.

Sources: 

CDC – Rheumatic Fever: All You Need to Know

PubMed – Rheumatic heart disease 

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