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Rheumatic Heart Disease

Rheumatic heart disease is a condition involving heart valve damage that was caused by rheumatic fever. Rheumatic fever can occur if streptococcal infections, like strep throat or scarlet fever, go untreated or aren’t properly treated. When these infections are not cared for effectively, the body may have an immune response that causes inflammation that can lead to damage of the heart valve. This damage is rheumatic heart disease.  

If your child has rheumatic heart disease, he or she may need to see a children’s heart specialist and may need to be treated at a children’s hospital that has experience treating this condition.

Causes of rheumatic heart disease

Rheumatic heart disease is caused by rheumatic fever, which is an inflammatory condition that affects connective tissue throughout the body, most often the heart, joints, brain, or skin. When someone has this disease, the heart valves may become inflamed and can scar over time, which may lead to narrowed or leaky heart valves. When the heart valves are leaky or narrow, the heart has a harder time pumping normally, which can lead to several complications. Heart failure is one of the more dangerous complications, and it may take years to develop after the onset of rheumatic heart disease. 

The most common age for rheumatic fever to occur is between the ages of 5 and 15; however, anyone at any age can get it. It’s a rare condition in the United States because most strep infections are treated effectively, but it does happen. And when it happens, the consequences can be serious. 

Children who get frequent strep throat infections are at the highest risk for developing rheumatic fever and rheumatic heart disease. If your child gets strep throat frequently, talk to his or her pediatrician about risks for rheumatic heart disease and what you should do to help prevent the infections.

Signs, symptoms, and complications of rheumatic heart disease

Rheumatic heart disease may be mild at first or not even be noticeable. If symptoms appear, they will depend upon the extent of damage to the heart muscle and valves and the location of any damage. 

  • If your child has rheumatic heart disease, he or she may have some or all of these symptoms:
    • Shortness of breath, especially when active or lying down
    • Swelling 
    • Chest pain

Since rheumatic heart disease is caused by rheumatic fever (which stems from an un- or under-treated streptococcal infection), it’s important for you to know the signs and symptoms of strep and rheumatic fever. The symptoms of rheumatic fever tend to begin between one and six weeks (usually about two weeks) after a streptococcal infection like strep throat. It’s possible that strep throat may be mild, so you may not seek treatment for your child (or even know your child is sick). It’s also possible that the strep bacteria may be undetectable by the time you take your child to the doctor. 

  • Symptoms of strep throat include:
    • Fever
    • Sore, red throat
    • Swollen glands
    • White spots in the back of the throat or near the tonsils
  • Symptoms of rheumatic fever may include:
    • Fever
    • General ill feeling
    • Red, painful, swollen joint or joints (commonly large joints like a knee, ankle, shoulder, or elbow); the pain and swelling usually lasts a day or two in one joint and may move to another joint
    • Skin rashes may appear for a short time, but this is not common
    • General weakness
    • Small lumps under the skin
    • Possible uncontrolled movements of the arms, legs, or muscles in the face
    • Shortness of breath may be noticeable if the heart is affected

Possible complications of rheumatic heart disease

  • Rheumatic heart disease can have several complications, including:
    • Heart failure from a leaky or narrowed heart valve
    • A bacterial infection (called bacterial endocarditis) of the lining of the heart
    • Pregnancy and childbirth complications from heart damage
    • A ruptured heart valve 

The complications of rheumatic heart disease can be severe and life threatening; however, the disease can be prevented. To prevent rheumatic heart disease, it’s important to take steps to prevent streptococcal infections and to treat them quickly and completely if they do occur. Proper treatment of strep infections is taking a full course of antibiotics. Any time your child’s doctor prescribes antibiotics to treat a bacterial infection, you should make sure you give the medication to your child exactly as prescribed and for as long as its prescribed. This is especially important with strep infections and is true even if your child feels better after a few days of treatment. 

(Please note, if your child has signs of an allergic reaction to the antibiotics, call your child’s pediatrician or seek medical attention right away. But don’t just stop the medication without medical advice.)

Diagnosing and treating rheumatic heart disease

One of the most important diagnostic criteria for rheumatic heart disease is a recent history of either a streptococcal infection like strep throat or rheumatic fever. There are two tests to check for current or recent strep infections – a throat culture and a blood test.

People who have rheumatic heart disease may have a heart murmur or a sound called a rub. Doctors may hear this during a routine physical exam or during an exam to check for rheumatic heart disease. A heart murmur occurs when blood leaks around damaged valves, and a rub occurs when inflamed tissues in the heart rub against each other. 

The following are some tests used to diagnose rheumatic heart disease.

  • Echocardiogram – An echocardiogram is an imaging test to view the chambers of the heart and its valves to see how the heart is functioning. It can show a variety of heart abnormalities, including heart valve problems and other problems caused by rheumatic heart disease.
  • Electrocardiogram (ECG or EKG) – An ECG is a test to record the electrical activity of the heart. It can show whether the heart is beating normally, and it can sometimes detect damaged heart muscles.
  • Chest x-ray – A chest x-ray takes images of the chest and can help doctors see if the heart is enlarged.
  • MRI of the heart – This is an imaging test that uses magnets to take pictures of the heart. It can help doctors see images of the heart that are more detailed than what an x-ray can show.
  • Blood tests – There are blood tests that can detect signs of inflammation or infection in the body, which are both signs of rheumatic heart disease. 

Treating rheumatic heart disease

It can be difficult to treat rheumatic heart disease, especially if significant damage has been done to the heart valves. 

People who have had rheumatic fever may have to take antibiotics every day or every month for the rest of their lives. This is done to prevent recurrent strep infections and to reduce the risk of heart damage. 

Some people require medication to reduce inflammation from rheumatic fever or rheumatic heart disease. Those medications may include aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), or steroids. 

If rheumatic heart disease leads to heart failure, people need to take medications to manage that condition. 

In some severe cases, people may need heart surgery to replace or repair their damaged heart valve.

For a referral to a Beaumont pediatric cardiologist, call 855-480-KIDS (855-480-5437) or find one online.