Rheumatic Heart Disease in Children

What is rheumatic heart disease?

Rheumatic heart disease is a condition of permanent damage to the heart valves. It is caused by rheumatic fever, which is a complication of an untreated bacterial infection with Streptococcus, or "strep." Strep throat or scarlet fever may eventually progress to rheumatic fever if it is not treated with antibiotics.

Who is at risk for rheumatic fever?

Rheumatic fever is uncommon in the U.S. It occurs in children who have had strep infections that were untreated or inadequately treated. Children ages 5 to 15, particularly if they have frequent strep throat infections, are most at risk for developing rheumatic fever.

Why is rheumatic fever a concern?

Rheumatic fever is an inflammatory disease that follows a strep infection. It can affect many tissues, especially the heart, joints, skin, or brain. The infection may cause heart damage, particularly scarring of the heart valves. This forces the heart to work harder than usual to pump blood. The damage may resolve on its own, or it may be permanent, eventually causing heart failure. Heart-related complications of rheumatic fever may develop months or even years after the initial strep infection. 

What are the symptoms of rheumatic fever?

The symptoms of rheumatic fever usually start about 1 to 5 weeks after your child has been infected with the Streptococcus bacteria. The following are the most common symptoms of rheumatic fever. However, each child may experience symptoms differently. Symptoms may include:

  • Joint inflammation. This includes swelling, tenderness, and redness over multiple joints. The joints affected are usually the larger joints in the knees or ankles. The inflammation "moves" from one joint to another over several days.

  • Small nodules or hard, round bumps under the skin

  • A change in your child's muscle control and movements. This is usually noted by a change in your child's handwriting and may also include unusual, jerky movements. May also have inappropriate behaviors associated with this.

  • A pink rash with large, round, circular edges may be seen on the trunk of the body or arms and legs. The rash may come and go. It is often described as "snake-like" in appearance. 

  • Fever

  • Weight loss

  • Fatigue

  • Chest pain or heart palpitations 

  • Shortness of breath 

  • Stomach pains

The symptoms of rheumatic fever may look like other conditions or medical problems. Always consult your child's health care provider for a diagnosis.

Treatment for rheumatic heart disease

Specific treatment for rheumatic heart disease will be determined by your child's health care provider based on age and specific symptoms.

The best treatment for rheumatic heart disease is prevention. Antibiotics can treat strep throat (a Streptococcus bacterial infection) and stop acute rheumatic fever from developing. Antibiotic therapy has sharply reduced the incidence and mortality rate of rheumatic fever and rheumatic heart disease.

Children who have previously contracted rheumatic fever are often given continuous (daily or monthly) antibiotic treatments to prevent future attacks of rheumatic fever and lower the risk of heart damage. This may continue until the child is at least 21 years old, or into adulthood.

If inflammation of the heart has developed medications may be given to reduce the inflammation. Other medications may be necessary to treat heart failure.

If significant heart valve damage occurs, surgical repair or replacement of the valve may be considered.