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 entirely 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 can start as a strep throat (bacterial infection of the throat) in childhood.

During rheumatic fever, the heart valves and other parts of your heart can become inflamed. This inflammation usually gets better. But sometimes your heart valves can become damaged. This damage interrupts the normal flow of blood through your heart.

Who is at risk of rheumatic heart disease?

Australia has some of the world's highest rates of rheumatic fever and rheumatic heart disease.

Rheumatic heart disease is more common in:

• Aboriginal and/or Torres Strait Islander peoples
• females
• people aged in their 20s and 30s

Researchers are looking at the role of genes in the development of rheumatic heart disease. This will help to explain why it's more common in some families.

When should I see my doctor?

See your doctor if you are sick and have:

• a fever and sore throat
• a 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.

They will see if you need to be treated for Strep A. They may do a throat swab to find the germ that is making you sick.

Your doctor will arrange a trans-oesophageal echocardiogram (TOE) — to look at your heart chambers and heart valves.

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 future 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

Not everyone with a sore throat will need antibiotics.

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 to go to a clinic every 3 to 4 weeks for penicillin injections.

These long-acting antibiotic injections are very important. 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 stopping rheumatic fever.

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

If you have a Strep A infection, you should stay away from other people.

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.