Rheumatic heart disease

Rheumatic heart disease happens when rheumatic fever causes permanent damage to the heart valves, making it harder for your heart to pump blood. Learn about the symptoms, how it’s treated and how to look after your heart if you have rheumatic heart disease.

Family standing together outside brick home, representing whānau support for rheumatic heart disease care and heart health in New Zealand

In this article

What is rheumatic heart disease?

Rheumatic heart disease (RHD) is long-term damage to the heart valves caused by rheumatic fever. 

Rheumatic fever is a serious illness that can develop after a Strep A throat infection, often called strep throat. In some people, their immune system (which fights infection) becomes over-active and can attack healthy parts of the body, including the heart. This can cause inflammation (irritation and swelling) that can stretch and scar the heart valves. 

The heart valves act like small doors that keep blood flowing in the right direction through the heart. When they’re damaged, they may not open or close fully. This can make it harder for blood to flow forward or cause some blood to flow backwards (called regurgitation or a leaky valve). This puts extra strain on your heart and makes it harder for it to pump blood around your body.   

Damage to the valves may remain even after the inflammation has settled.

Signs and symptoms of rheumatic heart disease

Rheumatic heart disease can occur after one or more episodes of rheumatic fever. It often develops slowly and symptoms may take years to appear.  

Some people have no symptoms and only find out they have heart valve damage during a check-up or heart scan. Others may notice symptoms that develop gradually, such as:  

  • breathlessness when active or lying down 
  • swelling in the legs, ankles, feet or stomach
  • a fast, irregular, pounding or fluttering heartbeat 
  • chest pain or discomfort
  • fatigue (feeling unusually tired or weak) 
  • fainting or feeling light-headed.

Symptoms can vary depending on which valve is affected. They may get worse slowly over time or appear for the first time during an illness or pregnancy, when the heart has to work harder. 

What are the complications of rheumatic heart disease?

Rheumatic heart disease can lead to a range of complications.   

  • Infective endocarditis: a serious infection on the heart valves. It’s caused by bacteria entering your bloodstream and travelling to the heart, which can happen after dental or surgical procedures, or from skin infections. 
  • Arrhythmias (irregular heartbeats): such as atrial fibrillation (AF), which can make your heartbeat fast, fluttering or uneven.  
  • Stroke: caused by blood clots that form in the heart or on damaged valves, especially if you have AF. 
  • Heart failure: may happen if damage is severe. It occurs when the heart can’t pump enough blood to meet the body’s needs, which can cause fluid to build up in the lungs or body. 
  • Pregnancy complications: pregnancy increases the amount of blood your heart needs to pump, which can put extra strain on the damaged valves.

How is rheumatic heart disease diagnosed?

An early sign of rheumatic heart disease may be a heart murmur that your doctor hears through a stethoscope. This sound happens when blood doesn’t flow smoothly through a damaged heart valve. It can occur if the valve is leaking or not opening properly. 

Your doctor will arrange for you to have an echocardiogram (echo). This is the main test used to diagnose rheumatic heart disease. It’s a painless scan that uses sound waves to show how your heart and valves are working. 

You may also have: 

  • blood tests to look for signs of inflammation or infection
  • an electrocardiogram (ECG) to check your heart’s rhythm 
  • a chest X-ray to check the size of your heart and your lungs. 

How is rheumatic heart disease treated?

Treatment focuses on protecting your heart and helping it work as well as possible. While rheumatic heart disease can’t be cured, the right care can stop it from getting worse and help manage any symptoms. 

After an episode of acute rheumatic fever, most people will need regular antibiotic injections (penicillin) for at least 10 years, or until they’re 21 years old, whichever is longer. If you have severe heart damage, you may need the injections for longer. This helps to stop new strep infections and protects your heart from further damage.  

You may also be prescribed medicines to help your heart pump better, control irregular heartbeats and prevent blood clots or fluid build-up. If a heart valve is badly damaged, you may need a procedure or surgery to repair or replace it. This helps improve blood flow and reduces strain on your heart. 

When you have rheumatic heart disease, even if you feel well, it’s important not to miss any hospital appointments and to have regular check-ups and heart scans. Rheumatic heart disease can change slowly over time and early treatment helps prevent serious complications. 

Support for people with heart conditions

Looking after your heart when you have rheumatic heart disease

Good ongoing care helps protect your heart and reduces the risk of further problems from rheumatic heart disease. This can include the following.  

  • Making sure you get your regular antibiotic injections. These protect your heart by stopping new strep infections that can cause rheumatic fever and more heart damage.
  • Taking antibiotics before some dental or surgical procedures. If you have severe valve disease, your doctor may give you antibiotics before some dental or surgical procedures, to prevent bacteria entering your blood and travelling to your heart. 
  • Having dental check-ups every 6 to 12 months. Keeping your teeth and gums healthy lowers the risk of infection from your gums or teeth spreading to your heart. 
  • Getting a flu vaccine every year. This helps protect your heart by reducing the risk of flu-related illness and complications that may damage your heart further.  
  • Getting a Pneumovax23 (pneumococcal) vaccine. Your doctor may recommend this vaccine to protect you from serious infections, such as pneumonia and meningitis. You’ll need another dose five years after the first one.   
  • Having regular heart check-ups. Your doctor will check how your heart valves are working and make sure your treatment is still right for you. 
  • Pregnancy care. If you’re planning to become pregnant, talk to your healthcare team early. They can help you plan a safe pregnancy and make sure you get the right care and monitoring for you and your baby. If you are pregnant, inform your lead maternity carer (LMC) that you have rheumatic heart disease or have had rheumatic fever. It is important to discuss the risk of any heart medicines during pregnancy with a doctor.

Where to get help and more information

Call the Heart Line or join the Heart Foundation NZ Support Group on Facebook.

Join a heart support group and connect with others living with a heart condition to share experiences, learn from others and get support. 

Read personal stories about people living with rheumatic heart disease.

Preventing rheumatic fever 
Valve surgery