Rheumatic Heart Disease

Rheumatic heart disease is long-term damage to one or more heart valves resulting from one or more episodes of acute rheumatic fever. It remains an important cause of heart disease in young people in parts of Africa and requires long-term monitoring and, in some cases, valve treatment.

• Shortness of breath, particularly on exertion, from valve damage affecting heart function
• Fatigue and reduced exercise tolerance
• Palpitations if an irregular heart rhythm develops
• A heart murmur is often found on examination, sometimes discovered incidentally before symptoms become noticeable
• In more advanced disease: symptoms of heart failure, such as leg swelling and breathlessness at rest

• Results from damage to the heart valves following one or more episodes of acute rheumatic fever, itself triggered by an abnormal immune response to untreated streptococcal throat infection.
• Repeated episodes of rheumatic fever increase the risk and severity of resulting valve damage.
• Most common in children and young adults in settings with limited access to prompt treatment for streptococcal throat infections.

• Suspected based on a heart murmur or symptoms of heart strain in someone with a known or possible history of rheumatic fever.
• Echocardiography is the key diagnostic test, showing the specific pattern and severity of valve damage.
• Assessment for other rheumatic fever-related complications and overall heart function supports management planning.

Long-term monthly injections of benzathine penicillin are continued for many years (often into adulthood, depending on severity and whether valve damage is present) to prevent further episodes of rheumatic fever and additional valve damage — this is the single most important part of long-term management.

Heart failure symptoms, if present, are managed with standard heart failure medicines, such as a diuretic and other supportive treatment.

An anticoagulant may be needed if an irregular heart rhythm or other risk factor for clot formation develops.

Significant valve damage causing major symptoms or heart strain may require specialist referral for consideration of valve repair or replacement surgery.

• Ensure strict, consistent adherence to long-term penicillin prophylaxis for anyone with a history of rheumatic fever.
• Seek prompt treatment for streptococcal sore throat in children and complete the full antibiotic course to prevent a first episode of rheumatic fever.
• Attend regular cardiac follow-up, including periodic echocardiography, to monitor valve function over time.
• Seek dental and procedural antibiotic guidance from a health worker where relevant, given a small risk of heart valve infection (endocarditis) with damaged valves.