Rheumatic Heart Disease: Causes, Symptoms and Prevention

Rheumatic heart disease, often called RHD, starts with a common throat or skin infection and can end with long-term damage to the heart valves. The WHO describes it as serious but preventable. This article explains what the WHO says about causes, symptoms and prevention.

What is rheumatic heart disease?

The WHO says RHD develops when rheumatic fever scars the heart valves. It describes RHD as the most common acquired heart disease in people under 25. The WHO estimates that about 55 million people are affected worldwide, and that it causes roughly 360,000 deaths each year, most of them in low- and middle-income countries.

How does it start?

The WHO explains that it begins with a throat or skin infection caused by group A streptococcus bacteria, which spread easily between people. In some people the immune system reacts to the infection by attacking the body's own tissues, including the heart valves. This reaction is rheumatic fever. Repeated episodes of rheumatic fever cause further valve damage.

The WHO says overcrowding, poverty and limited access to healthcare raise the risk. It is most common in children and adolescents in low- and middle-income countries and in marginalised communities.

Symptoms

The signs can be easy to mistake for a cold, a sore throat or growing pains at first, which is one reason medical review matters. The WHO lists these signs of rheumatic fever:

• Fever
• Painful, shifting joint pain, often in the knees, ankles, elbows or wrists
• Fatigue
• Involuntary jerky movements, called chorea
• A heart murmur
• Rarely, skin nodules or a distinctive rash

Once the valves are damaged, symptoms can include chest pain, shortness of breath, swelling in the abdomen, hands or feet, fatigue, and a rapid or irregular heartbeat. Other conditions can cause similar symptoms, so only a doctor can say what is happening.

Prevention

The WHO says that prompt antibiotic treatment of strep throat can prevent rheumatic fever. People who have had rheumatic fever need long-term antibiotics to prevent new infections, and the WHO says the standard option is an injection given every 3 to 4 weeks for many years. A doctor decides the right plan for each person. Wider strategies include better living standards, wider screening and care, a steady supply of quality antibiotics and national prevention programmes.

For this reason, do not ignore a sore throat that is severe or lasts, especially in a child, and do not stop a course of antibiotics early without talking to the doctor who prescribed it.

Treatment

Care is usually shared between a family doctor and a heart specialist, and it can continue for years. The WHO says there is no cure for RHD and valve damage is lasting. Severe cases often need surgery to repair or replace valves, though this is frequently unavailable or unaffordable in low-income settings. Medicines can help manage heart failure, rhythm problems and the risk of blood clots. The NHS describes how valve disease is checked with an echocardiogram and managed with check-ups, medicines or surgery, depending on severity.

When to see a doctor

See a doctor promptly if a child or young person has a sore throat that is severe or lasts, or has fever with painful joints, unusual jerky movements or a new heart murmur. If someone has already had rheumatic fever, keep to the follow-up plan.

Call emergency services at once for severe breathing difficulty, chest pain that is severe or does not stop, pale, blue or grey skin or lips, or fainting. Do not drive yourself to hospital.

In an emergency, call your local emergency number (112 in India, 911 in the United States).