Rheumatic Heart Disease: Causes, Symptoms & Treatment

Can a throat infection damage your heart? In certain cases, yes.

An infection caused by group A Streptococcus bacteria can trigger rheumatic fever, an inflammatory reaction that may affect the heart and its valves. If the valves are repeatedly inflamed, permanent scarring can develop, leading to rheumatic heart disease (RHD).

Recognising the early signs, understanding how RHD is diagnosed and knowing how recurrent rheumatic fever can be prevented can help protect the heart from further damage. Read along to understand the causes, symptoms, diagnosis and treatment of rheumatic heart disease.

What is Rheumatic Heart Disease?

Rheumatic heart disease (RHD) is long term damage to one or more heart valves caused by rheumatic fever. Rheumatic fever is an inflammatory illness that can develop after an infection with group A Streptococcus, commonly known as strep. In some people, the immune response to the infection triggers rheumatic fever, which can cause inflammation in the heart.

When the heart valves become inflamed, they can develop scarring and structural changes. Over time, a damaged valve may become narrowed, making it difficult for blood to pass through, or may fail to close properly, causing blood to leak backwards.

This lasting valve damage is called RHD (Rheumatic Heart Disease). RHD usually begins in childhood, although symptoms of valve disease may not appear until many years later. The World Health Organization estimates that around 55 million people worldwide are living with RHD.

What Causes Rheumatic Heart Disease?

The chain is usually:

Group A strep infection → rheumatic fever → inflammation of the heart → valve scarring → rheumatic heart disease

Strep throat is a common cause, although group A Streptococcus can also cause skin infections such as impetigo. Rheumatic fever does not develop after every strep infection. It affects you when the body’s immune response becomes misdirected.

Factors that increase the risk of RHD are:

• Overcrowded living conditions can increase the risk of infections that may lead to rheumatic fever.
• Limited access to healthcare can delay diagnosis and treatment of strep infections.
• Delayed or inadequate treatment of strep infections can increase the risk of rheumatic fever.

In children, an echocardiogram can sometimes detect heart valve changes that may not be found during a routine examination.

How Does Untreated Strep Throat Lead to Heart Damage?

A process called molecular mimicry plays a major role in this reaction.

After a group A strep infection, the immune system produces antibodies to fight the bacteria. In some people, these antibodies may mistakenly react with certain tissues in the body because they resemble parts of the bacteria.

This can cause inflammation in the heart, particularly the valves. Repeated episodes of rheumatic fever may gradually produce permanent scarring and structural changes.

Rheumatic fever does not usually show up right after a strep infection. It generally develops within 1 to 5 weeks.

What are the Symptoms of Rheumatic Heart Disease?

Rheumatic heart disease symptoms depend on whether a person is experiencing acute rheumatic fever or has developed chronic valve damage.

Early Symptoms During Rheumatic Fever

Rheumatic fever may cause:

• Fever
• Painful or swollen joints, particularly the knees, ankles, elbows and wrists
• Fatigue
• Chest discomfort or a fast heartbeat
• Shortness of breath when the heart is inflamed
• Involuntary jerky movements called chorea
• Occasionally, a characteristic rash or painless skin nodules

Heart inflammation, called carditis, may produce a new heart murmur. Importantly, some heart involvement can be detected only through echocardiography and may not produce obvious symptoms.

Long-Term Symptoms From Valve Damage

Rheumatic heart disease does not always cause symptoms in the early stages. They may develop gradually as the damaged valve starts affecting how the heart functions. The long term symptoms include:

• Breathlessness, particularly during activity or when lying down
• Persistent tiredness
• Chest discomfort
• Swelling of the feet, ankles or abdomen
• Rapid or irregular heartbeat
• Reduced exercise tolerance

A person may therefore develop RHD symptoms many years after the original rheumatic fever episode. The absence of symptoms immediately after childhood rheumatic fever does not necessarily mean there is no valve damage.

How is Rheumatic Heart Disease Diagnosed?

Diagnosis combines the person’s medical history, examination and heart investigations.

• Physical Examination & Medical History: The cardiologist reviews your symptoms and history of strep infection or rheumatic fever and checks for signs such as a heart murmur.
• Echocardiogram (ECHO): It uses ultrasound to check the heart valves and detect narrowing, leakage or other valve damage.
• Blood Tests: It is done to check for signs of inflammation and antibodies that may indicate a recent group A strep infection.
• Electrocardiogram (ECG): It records the heart’s electrical activity and helps identify abnormal heart rhythms or other electrical changes.

Complications of Rheumatic Heart Disease

Untreated or advanced RHD can lead to:

• Heart Valve Damage: A one-way valve in the left side of the human heart, called the mitral valve, is most commonly affected. Scarring can cause mitral stenosis, in which the valve becomes too narrow, or mitral regurgitation, in which blood leaks backwards. The aortic valve may also be affected.

• Heart Failure: Severe valve disease can place an increasing load on the heart and eventually lead to heart failure. In heart failure, the heart cannot pump blood effectively enough to meet the body’s needs.

• Arrhythmias: Enlargement of the heart chambers can lead to abnormal rhythms such as atrial fibrillation, which is an irregular heartbeat and can increase the risk of blood clots and stroke.

• Stroke: Atrial fibrillation and severe valve disease can increase the risk of clot formation, which may travel to the brain and block blood flow, causing a stroke.

• Infective Endocarditis: Damaged or abnormal heart valves can be vulnerable to infective endocarditis, a serious infection of the inner lining of the heart or its valves. Preventive measures depend on the individual’s overall health situation and current guidelines.

Rheumatic Heart Disease Treatment

The treatment approach depends on the severity of the condition, the valves affected and whether further episodes of rheumatic fever need to be prevented.

1. Treating the Strep Infection

Catching and treating a group A strep infection early is one of the most effective ways to prevent rheumatic fever from developing in the first place.

2. Long-Term Antibiotic Prophylaxis

For people who have already had rheumatic fever or been diagnosed with RHD, ongoing antibiotics are usually necessary to prevent another attack. This is known as secondary prophylaxis. How long the medication continues varies from person to person, depending on their age, whether they have had rheumatic fever before and the extent of any heart or valve involvement.

3. Managing Heart Complications

If the disease has led to complications like fluid buildup, heart failure or irregular heart rhythms, cardiologists may prescribe additional medications to manage these issues and reduce the risk of blood clots.

4. Surgery for Severe Valve Damage

When valve damage is very serious, surgery to repair or replace the affected valve may be needed. The right approach depends on which valve is involved, how severe the damage is and factors like the patient’s age and overall health.

When You Should See a Cardiologist

Rheumatic heart disease (RHD) usually begins with something as ordinary as a sore throat, which makes it easy to overlook until real damage has already been done. However, much of this damage is preventable. Treating strep infections timely, staying consistent with your medications and knowing the warning signs early can go a long way in protecting the heart valves from lasting harm.

So don’t ignore a sore throat, and don’t wait out breathlessness or unexplained fatigue. When it comes to rheumatic heart disease, early action is what helps you in the long run. If you have any concerns, whether about a past infection or new symptoms, a conversation with an internal medicine doctor or cardiologist can help clear the confusion. Book a consultation with the Cardiology Department at the CK Birla Hospital to get the right advice from a specialist.