Rheumatic Heart Disease in Children

What is rheumatic heart disease?

Rheumatic heart disease is a condition that causes permanent damage to the heart valves. It follows rheumatic fever. Rheumatic fever is the body's response to a strep infection of the throat or tonsils or "strep throat." Rheumatic fever may also follow scarlet fever. This is a strep infection of the throat along with a red, rough-feeling skin rash. Rheumatic fever may affect the joints, skin, tissue under the skin, brain, and heart. If it affects the heart, it is called rheumatic heart disease.

What causes rheumatic heart disease?

Rheumatic heart disease is caused by rheumatic fever. Rheumatic fever is a complication of an untreated or under-treated strep infection.

Who is at risk for rheumatic heart disease?

Rheumatic heart disease is uncommon in the U.S., because rheumatic fever is also not common. Rheumatic fever occurs more often in children between ages 5 and 15. This is especially true if they have had frequent cases of strep throat. Poor access to medical care is a risk factor for rheumatic heart disease as strep infections are more likely to be missed and go untreated.

What are the symptoms of rheumatic heart disease?

Your child may have signs and symptoms that affect the heart, including:

• Trouble breathing
• Chest pain
• Swelling (edema) of the feet and ankles
• Heart murmur

Your child may also have other signs and symptoms of rheumatic fever. These include:

• Joint pain and swelling 
• Rash
• Small, hard, round bumps under the skin (nodules)
• Irregular or jerky movements
• Belly (abdominal) pain
• Bloody nose
• Fever

The symptoms of rheumatic heart disease can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is rheumatic heart disease diagnosed?

The healthcare provider will ask about your child’s symptoms and health history, including having rheumatic fever or strep infections. He or she will give your child a physical exam. Your child may also have tests, such as:

• Throat culture
• Electrocardiography. A test to measure the electrical activity of the heart.
• Echocardiography. An imaging test that uses sound waves (ultrasound) to make detailed pictures of the heart.
• Blood tests

How is rheumatic heart disease treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Your child's healthcare provider will likely refer you to a pediatric cardiologist. This is a doctor with special training to treat heart problems in children. Your child may also see other specialists, depending on his or her symptoms.

Children with rheumatic heart disease will need to rest until their symptoms get better.

Your child’s healthcare provider may prescribe one or more of these medicines:

• Antibiotics to treat the acute strep infection
• Long-term antibiotics to prevent recurrent strep infection
• Steroids or nonsteroidal anti-inflammatory medicines to ease inflammation in the heart and in other parts of the body
• Water pills (diuretics) if heart failure develops
• Anti-inflammatory medicine for the management of fever and arthritis symptoms

Your child may also need other medicines. Some children need surgery to fix or replace damaged heart valves.

What are the complications of rheumatic heart disease?

Complications of rheumatic heart disease include:

• Permanent heart damage
• Heart failure
• Infection in the heart (endocarditis)

Can rheumatic heart disease be prevented?

You can help prevent rheumatic fever and rheumatic heart disease by knowing what strep throat looks like and getting treatment for it.  Your child’s healthcare provider can do a throat culture or rapid antigen detection test (RADT) to see if your child has strep throat.

Children with damaged heart valves from rheumatic heart disease need to keep their teeth and gums clean. They should also have regular dental exams with preventive antibiotics. These steps can help prevent infections of the damaged heart valves.

How is rheumatic heart disease managed?

Your child will need to have regular exams to check on his or her heart. He or she may also have repeat diagnostic tests of the heart.

If your child has had rheumatic fever, the healthcare provider may prescribe periodic antibiotics to take for several years or up to a certain age. The antibiotics keep rheumatic fever from coming back. They also lower the risk for heart damage. It is important that your child continue to take antibiotics as prescribed.

When should I call my child's healthcare provider?

Call your child's healthcare provider if your child has any of the following:

• Fever
• Trouble breathing
• Chest pain
• Swelling (edema) of the feet or ankles
• Another sore throat

Key points about rheumatic heart disease

• Rheumatic heart disease is long-term damage to heart valves that is a complication of rheumatic fever. Rheumatic fever stems from untreated strep infections.
• You can prevent rheumatic heart disease by knowing what strep throat looks like and getting treatment for it.
• Rheumatic heart disease is treated with rest and medicine. If valve damage occurs, your child may need surgery.

Next steps

Before you agree to the test or the procedure for your child make sure you know:

• The name of the test or procedure
• The reason your child is having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• When and where your child is to have the test or procedure
• Who will do the procedure and what that person’s qualifications are
• What would happen if your child did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or your child has problems
• How much will you have to pay for the test or procedure