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Rheumatic heart disease


Rheumatic heart disease (RHD) is the result of acute rheumatic fever (ARF). Rheumatic fever is the consequence of untreated strep throat caused by bacteria called Streptococcus. The risk of rheumatic heart disease is greater with recurrent episodes of ARF. ARF usually occurs between 5 and 15 years of age, but it can also occasionally occur in adults. RHD is particularly associated with damage to the valves of the heart.


The most obvious symptom for rheumatic heart disease is rheumatic fever. The symptoms for rheumatic fever are fever, joint inflammation, nodules under the skin, weight loss, rash, fatigue, and stomach pains. Once these symptoms persist, it is an indication of possible rheumatic heart disease.

The symptoms for rheumatic heart disease are:

  • Chest pain
  • Heart palpitations
  • Breathlessness on exertion
  • Orthopnea (breathing problems when lying down)
  • Paroxysmal nocturnal dyspnoea (waking from sleep with the need to sit or stand up)
  • Edema (swelling)
  • Syncope (fainting)
  • Stroke
  • Fever associated with infection of damaged heart valves.


The primary cause of rheumatic heart disease is rheumatic fever. Rheumatic fever results from a recurrent strep throat. Rheumatic fever damages the heart valves and if the heart valves are damaged, they will not function properly. When this damage to the heart valves is permanent, the condition is called rheumatic heart disease.

Risk Factors

The common risk factors for rheumatic heart disease include overcrowding, reduced access to medical care, and poverty. Recurrent acute rheumatic fever is the main cause of rheumatic heart disease. Once acute rheumatic fever is diagnosed further episodes have to be avoided to arrest progression of the disease. Appropriate treatment can manage symptoms and further reduce the risk of complications.


Complications of rheumatic heart disease include heart failure where the heart is not capable of pumping blood effectively and this strain causes the heart to enlarge. Other complications of rheumatic heart disease include infective endocarditis (infection of damaged heart valves) and stroke due to clot formation in the enlarged heart or on the damaged valves. These clots embolise (break off) and cause blockages in the blood vessels of the brain and also lead to a stroke.