Health Encyclopedia

Rheumatic Heart Disease in Children

What is rheumatic heart disease?

Rheumatic heart disease is a condition that causes permanent damage to the heart valves.

Rheumatic heart disease follows rheumatic fever. Rheumatic fever is the body's response to a strep infection of the throat or tonsils—"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.

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
  • Cough
  • 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
  • Lung infection (pneumonia)

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:

  • 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 strep infection
  • Steroids or nonsteroidal anti-inflammatory medicines to ease inflammation in the heart and in other parts of the body
  • Water pills (diuretics) for heart failure

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)

an 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 antibiotics to take all of the time. 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
  • Coughing 

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

Tips to help you get the most from a visit to your child’s healthcare provider:
  • Before your visit, write down questions you want answered.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Medical Reviewers:

  • Bass, Pat F. III, MD, MPH
  • MMI board-certified, academically affiliated clinician