Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. Rheumatic fever is an inflammatory disease that can affect many connective tissues, especially in the heart, joints, skin, or brain. It is caused by a bacterial infection called Streptococcus pyogenes (group A streptococcus) which can pass easily from person to person in the same way as other bacterial infections. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever. An immune response causes an inflammatory condition in the body which can result in ongoing valve damage.

Symptoms of rheumatic heart disease may include painful joints, especially knees, ankles, elbows, and wrists, pain that moves between different joints, fatigue, jerky uncontrollable body movements called ‘chorea’, painless nodules under the skin near joints, and/or a rash consisting of pink rings with a clear center (both rare). Symptoms of heart valve damage that is associated with rheumatic heart disease may include chest pain or discomfort, shortness of breath, swelling of the stomach, hands or feet, fatigue, rapid or irregular heartbeat.

Rheumatic heart disease can be prevented by preventing strep infections or treating them with antibiotics when they do occur. It’s important to take antibiotics as prescribed and to complete them as instructed, even if you feel better after a few days. There is no cure for rheumatic heart disease and the damage to the heart valves is permanent. Patients with severe rheumatic heart disease will often require surgery to replace or repair the damaged valve or valves. Depending on the severity of the disease, medication may also be needed to treat symptoms of heart failure.

Rheumatic heart disease is a preventable yet serious public health problem in low- and middle-income countries and in marginalized communities in high-income countries, including indigenous populations. Currently, a large proportion of those suffering from rheumatic heart disease are not diagnosed or are diagnosed at a late stage when damage to the heart is very severe. When long-term treatment is required, access to care becomes an even greater challenge.