Rheumatic heart disease doesn’t begin like most heart conditions. It’s not caused by high blood pressure, high cholesterol, or lack of physical activity — and it’s not something you’re born with.

Instead, rheumatic heart disease often begins with an untreated infection — usually strep throat. If left untreated, strep can lead to rheumatic fever, a condition that can cause long-term damage to the heart. The immune system overreacts to the infection, triggering inflammation that can harm the heart’s tissues — especially the valves.

Unlike other heart diseases, rheumatic heart disease often affects children and young adults. Most cases happen in developing countries where it’s harder to get medical care. But rheumatic heart disease can affect people anywhere. It’s more common in places where people can’t get treatment quickly for strep infections. In the United States, rheumatic fever and rheumatic heart disease are uncommon because antibiotics are widely available to treat strep.

Learn more about the causes, risk factors, symptoms, and treatment of rheumatic heart disease.

How Common Is Rheumatic Heart Disease?

The World Health Organization (WHO) estimates that rheumatic heart disease affects about 55 million people worldwide and causes around 360,000 deaths every year. In countries where rheumatic heart disease is more common, it causes 15 percent to 20 percent of all heart failure cases.

Risk Factors for Rheumatic Heart Disease

According to the WHO, most cases of rheumatic heart disease affect children and teenagers in low- and middle-income countries — especially those who live in crowded housing. The infections that lead to rheumatic heart disease are contagious and can spread quickly from person to person.

Rheumatic heart disease can also cause more problems during pregnancy. The WHO reports that it’s the most common kind of heart disease affecting pregnant women in countries where it’s more widespread. During pregnancy, increased blood volume places more pressure on the heart valves. This pressure can lead to irregular heartbeats, heart failure, and other complications for those living with rheumatic heart disease while pregnant.

Common Rheumatic Heart Disease Symptoms

When rheumatic fever sets in, it can cause a fever along with a variety of symptoms involving the joints. You might notice pain in your elbows, knees, ankles, and wrists. Affected joints can also appear swollen and red. You may develop a discolored, raised rash on the trunk of your body. Some people develop chorea, which causes shaky or jerky body movements they can’t control.

When rheumatic fever damages your heart valves and turns into rheumatic heart disease, you might have:

• Shortness of breath
• Chest pain or pressure
• Fatigue
• Arrhythmia (irregular heartbeat)
• Rapid heartbeat
• Swollen stomach, hands, and feet

Some of these symptoms may seem like unexpected signs of heart disease, so it’s important to inform your doctor about your symptoms so they can figure out the cause.

Diagnosing Rheumatic Heart Disease

Doctors diagnose rheumatic heart disease using a clinical evaluation, which includes reviewing your symptoms, medical history, and a physical exam. They can confirm that a person has recently had a strep infection using a blood test or throat swab.

During the exam, your doctor may listen to your heart for signs of a heart murmur. People with rheumatic heart disease often have heart murmurs because of blood leaking from damaged heart valves. You may also have a heart rub, a sound made when inflamed heart tissue rubs together.

Several tests help physicians diagnose rheumatic heart disease.

Echocardiogram

An echocardiogram creates a picture of the heart by bouncing sound waves off of it, which echo back to a handheld device called a transducer. You can see blood flowing in the image created by the echocardiogram, which helps your doctor see if there is heart valve damage and leaks.

Sometimes, healthcare professionals use other imaging tests like chest X-rays and MRI to check the heart for signs of rheumatic heart disease.

Electrocardiogram

An electrocardiogram (ECG) is a test that evaluates your heartbeat by recording the heart’s electrical activity on a graph. A healthcare professional sticks sensors to your chest to pick up on this electrical activity. An electrocardiogram can detect an arrhythmia from rheumatic heart disease and might help your doctor detect heart muscle damage.

Treatments for Rheumatic Heart Disease

If rheumatic heart disease isn’t treated, it can severely damage the heart. It can cause long-term disability because heart valve damage can’t be reversed. Doctors choose treatment based on how much damage there is to the heart valves.

Medications for Symptoms

Medications can target and reduce specific symptoms of rheumatic heart disease, like arrhythmias. Your doctor might prescribe blood thinners to lower the risk of blood clots caused by problems like narrowed valves or atrial fibrillation (arrhythmia linked to rheumatic heart disease). Anti-inflammatory medications can lower inflammation and limit damage to your heart. Diuretics (also called water pills) may ease shortness of breath.

Antibiotics

It’s important to treat strep infections with antibiotics so you can prevent rheumatic fever and rheumatic heart disease. Antibiotics can also help keep rheumatic fever from coming back.

Surgery

If rheumatic heart disease is severe, you might need surgery to replace or repair damaged heart valves. A less invasive procedure called valvuloplasty can open up narrowed valves that don’t yet need full repair or replacement.

Heart Monitoring

When living with rheumatic heart disease, you should visit your doctor regularly so they can monitor your heart. Your doctor might tell you to avoid or limit certain activities based on your heart valve damage.

Is Rheumatic Heart Disease Preventable?

The most effective way to prevent rheumatic heart disease is to get treatment for a strep infection as soon as you know you have it. Be sure to finish all your antibiotics, even if you feel better after a few days. That way, the infection is completely gone.

As one MyHeartDiseaseTeam member warned, “My doctor says my mitral valve damage stems from a strep infection. If your throat is sore and you even suspect strep, get treatment.”

If you’ve already had rheumatic fever, avoiding future strep infections is important. The best way to do this is with long-term treatment using benzathine penicillin G, an injected antibiotic (sold as Bicillin L-A).

Even if you’ve never had rheumatic fever, you can prevent strep infections by washing your hands frequently and avoiding sharing cups and cutlery with people who are sick.

Rheumatic heart disease is more common in countries where people have limited access to medical care. That’s because untreated infections like strep throat — which can lead to rheumatic fever — are harder to catch and treat early. Improving access to clean housing and healthcare can help prevent rheumatic heart disease, but those changes aren’t always possible in every community.

Talk to Your Doctor

Call your doctor if you’ve ever had rheumatic fever or are concerned about rheumatic heart disease for any reason. They can give you more tips for preventing future strep infections and keeping your heart valves healthy to avoid complications like heart failure.

You should also contact your doctor right away if you have rheumatic heart disease and notice symptoms like chest pain or shortness of breath getting worse.

Find Your Team

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 62,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Have you been diagnosed with rheumatic heart disease? Which treatments have worked best to manage your symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.