Rheumatic heart disease is the most commonly acquired heart disease in people under age 25, and mostly affects children and adolescents in low- and middle-income countries.Rheumatic heart disease results from damage to heart valves caused by one or several episodes of rheumatic fever, an autoimmune inflammatory reaction to throat infection with group A streptococci (streptococcal pharyngitis or strep throat). It most commonly occurs in childhood, and can lead to death or life-long disability. Every year, the disease claims 288,348 lives worldwide. It also accounts for about 2% of deaths from cardiovascular diseases—the number one cause of death globally.Despite it being eradicated in many parts of the world, the disease remains prevalent in sub-Saharan Africa, the Middle East, Central and South Asia, the South Pacific, and among immigrants and older adults in high-income countries, especially in indigenous peoples.
Rheumatic heart disease starts as a sore throat from a bacterium called Streptococcus pyogenes (group A streptococcus) which can pass easily from person to person in the same way as other upper respiratory tract infections. Strep infections are most common in childhood. In some people, repeated strep infections cause the immune system to react against the tissues of the body including inflaming and scarring the heart valves. This is what is referred to as rheumatic fever. Rheumatic heart disease results then from the inflammation and scarring of heart valves caused by rheumatic fever. Rheumatic fever symptoms can include:
- painful joints especially knees ankles, elbows and wrists
- pain that moves between different joints
- jerky uncontrollable body movements called ‘chorea’
- painless nodules under the skin near joints and/or a rash consisting of pink rings with a clear centre (both rare)
- heart murmur
- chest pain or discomfort
- shortness of breath
- swelling of the stomach, hands or feet
- rapid or irregular heart beat
There is no cure for rheumatic heart disease and the damage to the heart valves are permanent. Patients with severe rheumatic heart disease will often require surgery to replace or repair the damages valve or valves. Depending on the severity of disease, medication may also be needed to treat symptoms of heart failure or heart rhythm abnormalities. Medications which thin the blood to reduce the risk of blood clots may also be needed. In the case of serious disease, surgery may be required to repair or replace the heart valves. Rheumatic heart disease is preventable. Since rheumatic heart disease results from rheumatic fever, an important strategy is to prevent rheumatic fever from occurring. Treatment of strep throat with appropriate antibiotics will prevent rheumatic fever. Once a patient has been identified as having had rheumatic fever, it is important to prevent additional streptococcal infections as this could cause a further episode of rheumatic fever and additional damage to the heart valves. The strategy to prevent additional streptococcal infection is to treat a patient with antibiotics over a long period of time. The antibiotic treatment that is most effective in preventing further infection is benzathine penicillin G, which is given by intramuscular injection every 3-4 weeks over many years.