Rheumatic Heart Disease: Causes and Preventions

     Many parents may assume it is merely a common cold when children fall ill with a sore throat and high fever. However, did you know that a seemingly minor condition such as bacterial pharyngitis could be the starting point of a serious illness like rheumatic fever, which can lead to rheumatic heart disease in children?

What Causes Rheumatic Fever?

     Rheumatic fever is caused by an infection with Group A Streptococcus bacteria, which are responsible for conditions such as strep throat, scarlet fever, and impetigo (a skin infection). In response to the infection, the body’s immune system may overreact, leading to inflammation or swelling in the joints, brain, skin, and—most seriously—the heart valves.

Symptoms Typically Appear 1–5 Weeks After Infection

     Even if the initial infection appears to have resolved, rheumatic fever can still develop 1 to 5 weeks after an infection with Group A Streptococcus. Additionally, individuals infected with this bacteria can transmit it to others.

Symptoms of Rheumatic Fever:

• Fever
• Joint pain, especially in the knees, ankles, elbows, and wrists
• Chorea — involuntary, jerky movements of the body
• Fatigue or a feeling of tiredness
• Small, painless lumps under the skin near joints
• Ring-shaped pink rashes with clear centers (rare)
• Heart murmurs may be audible

The Heart: The Most Concerning Organ

     If rheumatic fever is not treated promptly, it may progress to rheumatic heart disease. This condition involves damage or malfunction of the heart valves between the heart chambers. Rheumatic heart disease can weaken the heart, and in severe cases, may require heart surgery and can even be life-threatening.

Signs of Rheumatic Heart Disease May Include:

• Chest pain
• Abnormally fast heartbeat
• Shortness of breath or difficulty breathing
• New heart murmur
• Enlarged heart
• Fluid accumulation around the heart

Risk of Recurrence

     Individuals who have previously had rheumatic fever are at increased risk of recurrence if they are re-infected with Group A Streptococcus.

Prevention and Treatment

     Since rheumatic fever stems from a Group A Streptococcus infection, timely diagnosis and appropriate treatment of initial infections such as pharyngitis or skin infections using antibiotics can prevent the progression to rheumatic fever and, ultimately, rheumatic heart disease.

Advice from a Pediatric Cardiologist

     For individuals with a history of rheumatic fever, doctors may recommend continuous antibiotic therapy (known as secondary prevention) to prevent reinfection and reduce the long-term risk of heart complications.