Rheumatic Heart Disease — Causes, Symptoms, Treatment and Prevention

Rheumatic heart disease (RHD) is lasting damage to the heart's valves that begins with something as ordinary as a sore throat. It has almost disappeared from wealthy countries, but around 40 million people worldwide still live with it, and India carries a large share of them. It is also one of the most preventable heart diseases there is.

How a Sore Throat Becomes Heart Disease

The trigger is a throat infection with group A Streptococcus bacteria ("strep throat"), most often in children aged 5 to 15. In a small number of children who are not treated with antibiotics, the immune system reacts to the infection and, two to four weeks later, attacks the body's own tissues. This is acute rheumatic fever. It inflames the joints, skin and brain — and the heart.

The joints recover completely. The heart valves may not. Each new strep infection can bring another attack of rheumatic fever, and each attack adds scarring. Over years, the valves — most often the mitral valve, and sometimes the aortic valve — become thickened and stiff (stenosis) or stop closing properly (regurgitation). That lasting damage is rheumatic heart disease.

Signs of Rheumatic Fever in a Child

• A sore throat, followed two to four weeks later by fever
• Painful, swollen joints — often knees, ankles, elbows or wrists — with the pain moving from one joint to another
• Breathlessness, chest pain or a new heart murmur heard by the doctor
• Jerky, uncontrolled movements of the face, hands or feet (Sydenham's chorea)
• A faint, ring-shaped rash or small painless lumps under the skin

Symptoms of Rheumatic Heart Disease

Valve damage can stay silent for years. When symptoms appear, they usually come on gradually:

• Breathlessness on exertion, and later when lying flat or at night
• Tiredness and reduced ability to work or walk
• Palpitations — often from atrial fibrillation, an irregular rhythm common in mitral valve disease
• Swelling of the feet and ankles
• Coughing up blood-stained sputum in severe mitral stenosis

Pregnancy places extra load on the heart, and it is not unusual for RHD to be discovered for the first time when a woman becomes breathless in pregnancy. If you have had rheumatic fever or know you have a valve problem, see a cardiologist before planning a pregnancy.

How It Is Diagnosed

The key test is an echocardiogram — an ultrasound of the heart that shows which valves are affected, how narrow or leaky they are, and how well the heart is pumping. An ECG looks for atrial fibrillation and strain on the heart, and a chest X-ray shows enlargement and fluid in the lungs. When active rheumatic fever is suspected, blood tests such as ASO titre, ESR and CRP help confirm a recent strep infection and ongoing inflammation.

Treatment

• Penicillin prophylaxis: a benzathine penicillin injection every three to four weeks prevents new strep infections and so prevents further valve damage. It is continued for years — often until the age of 21 to 40, depending on how badly the heart has been affected. Missing injections is the commonest reason RHD gets worse.
• Medicines for symptoms: diuretics to clear fluid, medicines to control heart rate, and blood thinners for patients with atrial fibrillation or severe mitral stenosis, who are at high risk of stroke.
• Balloon mitral valvotomy: for suitable patients with mitral stenosis, a balloon passed through a vein in the leg opens the narrowed valve without open-heart surgery.
• Valve repair or replacement: surgery when a valve is too damaged for a balloon procedure, or when it leaks severely.

If a valve procedure is needed, your cardiologist will explain which option suits your valve and when it is best done. The timing matters: treated before the heart muscle is permanently weakened, most patients return to normal activity.

Prevention Starts With a Sore Throat

Rheumatic heart disease is preventable at two points. First, a child with a sore throat and fever — especially without a cold or cough — should see a doctor; a full course of antibiotics (usually penicillin or amoxicillin for ten days) clears the strep infection before rheumatic fever can begin. Second, anyone who has had rheumatic fever should never miss their penicillin injections. Less crowded living conditions and good hand hygiene also reduce how often strep spreads among children.

Valve Care at Oxford Hospital

Oxford Hospital Jalandhar's cardiology department offers echocardiography, ECG and Holter monitoring, long-term penicillin prophylaxis plans and follow-up for rheumatic valve disease. Cardiac care is cashless under PMJAY, CGHS, ECHS and major insurers. To book, call +91 98550 00028.