In rheumatic heart disease (also called rheumatic fever), the heart valves are damaged by substances (antibodies) that the body produces to fight streptococcal (strep) infection.
It is not clear why, but rheumatic heart disease affects only a small percentage of those infected with strep throat or other strep infections. Because of the availability of medicines to treat strep infections, rheumatic fever is no longer common in the United States.
Symptoms of Rheumatic Fever
Symptoms of damage to the heart valves caused by rheumatic fever may not be noticed for some time. Eventually, damaged heart valves can cause serious, even disabling, problems. These problems depend on how severe the damage is and which heart valve is affected. The most advanced condition is congestive heart failure, in which an enlarged heart is unable to pump sufficient blood to the body.
There are other symptoms associated with rheumatic fever that are not heart related. These include joint pain and swelling that changes through different joints, skin rash (typically on the trunk or arms), subcutaneous nodules (painless bumps that typically appear on the back of the wrist, outside elbow, or front of the knees), or abnormal rapid limb movements.
Progression and Possible Complications of Rheumatic Fever
Damage to the heart and valves can be permanent or temporary. Damage to a valve can cause narrowing (stenosis), so that the valve no longer allows enough blood to flow through. Or damage can prevent the valve from closing properly and lead to valve “leakage,” in which blood flows backward in the heart.
Changes noted in the early part of the disease are due to inflammation and dilation (stretching and weakening) of the heart muscle. These changes are reversible in most cases. Even changes in the cardiac valves may return to normal.
However, in a certain percentage of patients, the damage persists.
Heart valve damage can lead to serious problems. If significant damage develops, congestive heart failure may result. In heart failure, the heart is unable to supply enough blood to the rest of the body.
Children with rheumatic heart disease may develop a chronic condition due to their damaged cardiac valves. Each time rheumatic fever occurs, the chances increase for further damage to the heart valves.
If the heart has been damaged by rheumatic fever, patients are also at increased risk for developing infective endocarditis, an infection of the heart's lining or valves.
Treatments for Rheumatic Fever
Treatments for rheumatic heart disease include antibiotics (penicillin) to stop the strep infection. They also include taking preventive doses of antibiotics to stop future strep infections before they begin. If a child is diagnosed with rheumatic fever, he or she will need to take antibiotics (either by mouth every day or by shot once a month) until adulthood to prevent future infections. Children can become very sick with subsequent infections.
If rheumatic fever leads to suspected endocarditis:
- Aspirin may be given
- Steroids may be given
- Medications for congestive heart failure may be prescribed
If there is significant damage to the heart valve, surgical repair or replacement with a prosthetic (artificial) heart valve may be recommended.