What is rheumatic heart disease?

Rheumatic heart disease is a condition that develops when your heart valves are damaged following rheumatic fever. It can involve one or more of your heart valves (you have 4 altogether).

Rheumatic heart disease is a serious condition that is preventable.

What are the symptoms of rheumatic heart disease?

Your symptoms will depend on how damaged your heart is.

People with mild rheumatic heart disease may have no symptoms. However, your doctor may be able to hear a heart murmur (abnormal heart sound) when using a stethoscope.

As rheumatic heart disease gets worse, your heart must work harder to pump blood. But your symptoms may not reflect the severity of the disease.

Symptoms of rheumatic heart disease include:

• chest pain
• shortness of breath when exercising or lying down
• weakness and tiredness
• heart palpitations (being aware of your heartbeat)
• swollen feet, legs and face

What causes rheumatic heart disease?

You can develop rheumatic heart disease if you have had rheumatic fever.

Rheumatic fever is an autoimmune response to a strep throat (bacterial infection of the throat) or Strep A skin infection in childhood.

For some people who have rheumatic fever, the heart valves and other parts of the heart can become inflamed. This can cause damage to the heart valves, which interrupts the normal flow of blood through your heart.

Who is at risk of rheumatic heart disease?

In Australia, rheumatic heart disease is more common in:

• Aboriginal and/or Torres Strait Islander peoples
• New Zealand Māori and Pacific Islanders
• females
• people aged in their 20s and 30s

When should I see my doctor?

See your doctor if you develop any of the above cardiac symptoms, especially if you’ve had a recent fever, sore throat or skin infection.

If you have previously had rheumatic fever, your doctor should already be monitoring you.

How is rheumatic heart disease diagnosed?

Your doctor will talk with you about your symptoms and your medical history. They will examine you and listen to your heart with a stethoscope.

To diagnose RHD, your doctor will arrange an echocardiogram (an ultrasound of your heart) to look at your heart valves and the flow of blood through the heart.

How is rheumatic heart disease treated?

The treatment of rheumatic heart disease is designed to do 2 things:

1. manage problems caused by any heart damage you have now
2. prevent further damage

To manage any heart problems you have now, your doctor may give you medicine to:

• keep your heartbeat regular
• regulate the amount of fluid in your body
• prevent blood clots forming on your damaged heart valves

Follow-up care for rheumatic heart disease

If you have rheumatic heart disease, you will need regular check-ups with:

• clinic staff
• specialists
• dentists

Rheumatic heart disease can get worse if you have rheumatic fever again. To prevent this, you will need regular penicillin injections every 3 to 4 weeks.

These long-acting antibiotic injections help protect your heart. Never miss or stop getting your injections without talking to a doctor.

You must also take very good care of your teeth. Regular brushing and dental checks reduce the risk of infections of the heart.

Surgery

You may need surgery to repair or replace your heart valves.

This will help to control your symptoms and reduce the amount of work your heart is doing. It does not cure rheumatic heart disease.

Can rheumatic heart disease be prevented?

Rheumatic heart disease can be prevented, by preventing rheumatic fever.

Rheumatic fever can be prevented by seeing the doctor or nurse whenever you're sick with a sore throat or skin infection and getting treatment quickly.

Preventing rheumatic heart disease with antibiotics

If you have already had rheumatic fever, you can avoid rheumatic heart disease by having regular antibiotic injections. This is called prophylaxis.

The antibiotics are usually given as long-acting penicillin injections. You will need to get these:

• every 3 to 4 weeks
• for at least 10 years after your diagnosis

The frequency and length of antibiotic treatment depends on:

• your rheumatic fever history
• whether your heart valves are damaged
• your risk of getting another Strep A infection and developing rheumatic fever again

Complications of rheumatic heart disease

Complications of rheumatic heart disease include:

• stroke
• heart failure
• heart arrhythmias (a rapid or irregular heartbeat)
• endocarditis (infection of damaged heart valves)
• complications during pregnancy

More than 1 in 4 people will get complications within 8 years of being diagnosed with rheumatic heart disease.

Resources and support

The Heart Foundation has information on acute rheumatic fever and rheumatic heart disease, including a video on prevention.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.