Rheumatic heart disease is damage to one or more of the heart valves caused by rheumatic fever, an inflammatory condition triggered by an untreated or inadequately treated Group A streptococcal throat infection (strep throat). Rheumatic fever causes the immune system to attack the body’s own tissues, including the heart valves, leading to inflammation and scarring.
Repeated episodes of rheumatic fever (which can occur if streptococcal infections recur) progressively worsen valve damage. The mitral valve is most commonly affected, followed by the aortic valve. The damaged valve may become narrowed (stenotic), leaky (regurgitant), or both. In severe cases, rheumatic heart disease can lead to heart failure, atrial fibrillation (due to enlarged chambers from chronic valve disease), stroke, and in some cases sudden cardiac arrest from arrhythmia.
Rheumatic heart disease is now relatively uncommon in the UK due to widespread antibiotic treatment of streptococcal infections, but it remains a leading cause of acquired heart disease in low- and middle-income countries. Patients who have had rheumatic fever as children may only develop clinically significant valve disease in adulthood, decades after the original infection.
Management depends on severity. Moderate to severe valve disease is monitored with regular echocardiography. When valve dysfunction is causing symptoms or significant cardiac strain, valve repair or replacement surgery is considered. People with a history of rheumatic fever may be prescribed long-term penicillin prophylaxis to prevent recurrent streptococcal infections and further valve damage.
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