What is Rheumatic Heart Disease?

Rheumatic heart disease (RHD) occurs when the heart valves are damaged as a result of acute rheumatic fever. If you suffer from RHD, blood cannot flow through your heart properly as your heart valves have trouble opening and closing.

In Australia, rheumatic heart disease is very prevalent in remote Aboriginal and Torres Strait Islander communities where acute rheumatic fever is common.

What are the symptoms of Rheumatic Heart Disease?

You may not always have symptoms if you have rheumatic heart disease. However, some warning signs include:

• Breathlessness during activity
• Chest pain
• Fainting
• Fever related to infection of damaged heart valves
• Heart palpitations
• Stroke
• Swelling
• Trouble breathing when lying down
• Waking from sleep and needing to sit or stand up

What are the possible complications of Rheumatic Heart Disease?

If you have a severe case of rheumatic heart disease you may experience a number of complications including heart failure,  stroke, endocarditis, atrial fibrillation, progressive disability, and complications with pregnancy and delivery.

What causes Rheumatic Heart Disease?

Rheumatic heart disease is caused by acute rheumatic fever or recurring rheumatic fever which has been left untreated.

Acute rheumatic fever is an inflammatory disease that develops if strep throat or scarlet fever – an infection with Group A streptococcus bacteria – is left untreated without antibiotics. Acute rheumatic fever is prevalent in developing nations or disadvantaged communities and most common among 5-15 year olds.

If you are susceptible you may experience an immune response if your strep throat is not addressed. This response can then target the brain, skin, joints and heart and may cause inflammation.

What are the risk factors for Acute Rheumatic Fever? 

Your risk of acute rheumatic fever is higher if you have: 

• An overcrowded household
• High levels of exposure to streptococcus bacteria
• Individual susceptibility for strep throat to develop into acute rheumatic fever
• Recurring strep throat infections (in children)
• Personal history of acute rheumatic fever (in adults over 40 years old)

How is Rheumatic Heart Disease diagnosed?

To diagnose rheumatic heart disease, your doctor may conduct one of the following tests: 

• Physical examination
• Medical history to check for past acute rheumatic fever or strep infection
• Chest X-ray
• Electrocardiogram (ECG)
• Echocardiogram

What treatments are available for Rheumatic Heart Disease?

The type of treatment will depend on the severity of the rheumatic heart disease. Some options include:

• Medication to treat infection
• Balloons inserted through a vein to open up a valve
• Blood-thinning medicine to prevent stroke or to prepare for a heart valve replacement
• Heart valve surgery to repair or replace damaged heart valves
• Heart transplant 

How can I minimise complications relating to Rheumatic Heart Disease? 

Options available to reduce the risk of complications from rheumatic heart disease include:

• Regularly visiting a Cardiologist
• Annual flu vaccinations
• Early diagnosis of sore throats
• Practicing good dental hygiene
• Receiving appropriate prenatal care

How can Rheumatic Heart Disease be prevented?

Rheumatic heart disease and acute rheumatic fever are both entirely preventable.

Antibiotic treatments including penicillin to treat strep throat can dramatically reduce the risk of acute rheumatic fever and consequently rheumatic heart disease.

If you have acute rheumatic fever, prompt diagnosis from your doctor is essential, combined with the appropriate medication, in order to prevent it from worsening and deteriorating into heart failure.

In some cases, you may need to continue taking preventative antibiotics such as prophylactic antibiotics for many years after acute rheumatic fever. This will be decided by your doctor who will consider the severity of your situation.

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