Rheumatic Heart Disease: Causes, Symptoms, Diagnosis and More
Learn about rheumatic heart disease (RHD), its causes, symptoms, complications, and treatment options. Discover prevention strategies and long-term management tips for better heart health.
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Last updated on 3rd Jul, 2025
Rheumatic heart disease (RHD) is a lifelong condition resulting from permanent heart valve impairment due to rheumatic fever. This happens if an untreated or inadequately treated Group A streptococcal infection, e.g., pharyngitis or scarlet fever, sets off an autoimmune attack involving the heart, the joints, the skin, or even the brain. Heart damage usually develops with time, which progresses to complications such as heart failure or arrhythmias.
Rheumatic fever, the precursor to RHD, is a specific inflammatory disease that may arise as a complication of untreated or poorly controlled streptococcal infections. The immune system attacks normal tissue, such as the heart, in a misguided attempt to fight the bacteria.
In this autoimmune response, the main focus is on the heart valves and subsequent scarring and deformation that are characteristic of RHD. The prevalence of the condition is higher in low-income areas, where access to health care and antibiotics is restricted.
Causes and Risk Factors
The primary cause of RHD is a preceding infection with Group A Streptococcus (GAS), which causes illnesses like strep throat. If untreated, the bacteria can trigger an abnormal immune response that damages the heart valves. Repeated infections exacerbate the risk of developing rheumatic fever and, subsequently, RHD.
Certain genetic factors also make some individuals more susceptible to rheumatic fever. Environmental factors, such as overcrowding, poor hygiene, and limited access to healthcare, also play a significant role in the spread of GAS infections. These factors are why RHD is more prevalent in developing countries and among disadvantaged populations.
Symptoms and Signs
Common symptoms of rheumatic fever include:
Fever and fatigue
Painful, swollen joints, often affecting the knees, elbows, wrists, etc.
Skin rashes or nodules, particularly over bony areas
Involuntary muscle movements, known as Sydenham chorea, affecting coordination
When rheumatic fever progresses to involve the heart, symptoms may include chest pain, shortness of breath, and palpitations. The inflammation often affects the mitral and aortic valves, leading to conditions like mitral stenosis or regurgitation. Over time, the damaged valves may cause heart murmurs, fluid retention, or heart failure.
Diagnosing RHD involves a combination of clinical evaluation and diagnostic tests to confirm valve damage and its underlying causes.
Clinical Assessment:
A comprehensive medical history is taken to identify untreated streptococcal infections or past episodes of rheumatic fever.
Healthcare providers evaluate symptoms indicating heart involvement, such as fatigue or shortness of breath.
Physical examination may reveal heart murmurs or other signs of valve abnormalities.
Additional Tests:
Electrocardiograms (ECGs): Analyse heart rhythm irregularities.
Blood Tests: Identify markers of inflammation and evidence of recent streptococcal infection.
Echocardiography: Provides detailed imaging of heart valves to assess structural damage and functional impairment.
Complications of Rheumatic Heart Disease
Rheumatic heart disease (RHD) can lead to severe complications, primarily due to long-term damage to the heart valves. The inflammation and damage due to rheumatic fever can often result in valve dysfunction, such as
Stenosis (narrowing)
Regurgitation (leakage)
Over time, this valve damage increases the heart's workload, leading to heart failure. Symptoms like breathlessness, fatigue, and fluid retention commonly occur as the condition worsens.
Beyond the heart, RHD can have systemic effects. These include:
Blood Clots and Stroke: Abnormal blood flow through damaged valves increases the likelihood of clot formation, which can cause strokes if clots travel to the brain.
Arrhythmias: Chronic inflammation and structural damage to the heart can disrupt its normal rhythm.
Infective Endocarditis: Damaged valves are more susceptible to infection, which can result in a life-threatening condition.
These complications highlight the demand for vigilant monitoring and comprehensive care to cut down the risks associated with RHD.
Treatment Options
Managing RHD requires a combination of medical therapies and, in severe cases, surgical interventions. Some of them include:
Medical Management: Focuses on symptom relief, preventing complications, and controlling streptococcal infections.
Antibiotic Prophylaxis: Essential for individuals with a history of rheumatic fever to prevent recurrent infections and further heart damage.
Medications:
Diuretics: Alleviate fluid retention and reduce strain on the heart.
Beta-blockers: Help manage heart failure and improve cardiac function.
Anticoagulants: Reduce the risk of blood clots.
Surgical Interventions:
Valve Repair: Restores the normal function of damaged valves.
Valve Replacement: Involves implanting a mechanical or biological valve when a repair is not feasible.
These procedures can improve heart function, alleviate symptoms, and enhance the overall quality of life for patients with severe RHD.
Consult Top Doctors for Personalised Treatment
Prevention Strategies
Preventing rheumatic heart disease (RHD) requires a two-pronged approach: addressing the root cause early and managing risks in those already affected.
Primary Prevention:
Treat Group A streptococcal infections (e.g., strep throat) promptly with antibiotics to prevent rheumatic fever.
Raise public awareness about the symptoms of strep infections to encourage timely medical attention.
Improve hygiene and reduce overcrowding in high-risk populations to limit the spread of infections.
Secondary Prevention:
Use long-term antibiotic prophylaxis to prevent recurrent strep infections and further damage to heart valves in individuals with a history of rheumatic fever.
Incorporate lifestyle changes such as:
Following a balanced diet to support heart health.
Regular physical activity to improve overall cardiovascular fitness.
Stress management techniques, such as mindfulness or relaxation exercises, to reduce the strain on the heart.
By focusing on early treatment and long-term care, these strategies can significantly reduce the incidence and progression of RHD, improving outcomes for individuals and communities.
Prognosis and Long-Term Outlook
The prognosis for individuals with RHD depends on several factors, including the extent of valve damage and access to timely medical care. Proper management and early intervention can significantly improve outcomes.
Key Determinants of Prognosis:
Severity of valve damage impacts complications such as heart failure or arrhythmias.
Timely diagnosis and access to treatment improve disease control and outcomes.
Outcomes in Different Settings:
Resource-Rich Settings: Access to advanced diagnostics, medications, and surgical options like valve repair or replacement helps stabilise the condition and enhance quality of life.
Resource-Limited Regions: Delayed diagnosis and limited access to care increase the risk of complications and poorer outcomes.
Role of Proper Management:
Lifelong antibiotic prophylaxis prevents recurrent infections that worsen valve damage.
Regular medical follow-ups monitor disease progression and guide treatment adjustments.
Lifestyle changes, such as a heart-healthy diet, stress management, and appropriate physical activity, support overall health.
For many, these combined efforts can result in a near-normal life expectancy, highlighting the importance of comprehensive care and patient education.
Impact on Global Health
RHD disproportionately affects low- and middle-income countries, where overcrowding, limited healthcare access, and poor hygiene increase the risk of streptococcal infections. The disease remains a significant cause of morbidity and mortality in these regions, placing a substantial burden on healthcare systems.
Global initiatives, such as the World Health Organisation’s programs for RHD prevention and control, aim to reduce its prevalence. These efforts focus on improving access to antibiotics, raising public awareness, and enhancing healthcare delivery in vulnerable populations. Despite progress, RHD continues to highlight global health disparities.
Living with Rheumatic Heart Disease
Living with RHD requires proactive self-care and monitoring. Patients are encouraged to maintain regular follow-ups with healthcare providers to monitor heart health and adjust treatment plans as needed. Self-care practices, such as adhering to medications, managing weight, and maintaining a heart-healthy diet, can help reduce symptoms and prevent complications.
Support groups and educational resources provide valuable assistance for individuals and families affected by RHD. These resources offer emotional support, practical advice, and a sense of community, helping patients navigate the challenges of living with a chronic condition. Empowering individuals with knowledge and access to care remains essential in improving their quality of life.
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Consult Top Doctors for Personalised Treatment
Dr. Mangesh Danej
Cardiologist
8 Years • MBBS, MD (General Medicine), DNB (Cardiology)
Pune
Dr Danej clinic, Pune
(375+ Patients)
Dr. Pinaki Nath
Cardiologist
8 Years • MBBS, MD General Medicine, DM Cardiology
Barasat
Diab-Eat-Ease, Barasat
Dr. Dixit Garg
Cardiologist
10 Years • MBBS , DNB (General medicine) , DNB (cardiology)
Gurugram
Smiles & Hearts, Gurugram
Dr. Amit. A. Bharadiya
Cardiologist
12 Years • MBBS, MD General Medicine, DNB Cardiology, FSCAI
Maharashtra
Surabhi Hospital, Maharashtra, Maharashtra
Dr. Sibashankar Kar
Cardiologist
10 Years • MBBS, DNB
Bhubaneswar
Hi-Tech Medical College & Hospital, Bhubaneswar
