Rheumatic Heart Disease in Children

What is rheumatic heart disease?

Rheumatic heart disease is a condition in which permanent damage to heart valves is caused by rheumatic fever. The heart valve becomes damaged by a process that generally begins with an infection caused by bacteria called Streptococcus. Strep throat or scarlet fever may eventually progress to rheumatic fever.

Who is at risk for rheumatic fever?

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

Why is rheumatic fever a concern?

Rheumatic fever, an inflammatory disease, can affect many connective tissues, especially in the heart, joints, skin, or brain. The infection often causes heart damage, particularly scarring of the heart valves, forcing the heart to work harder to pump blood. The damage may resolve on its own, or it may be permanent, eventually causing congestive heart failure (a condition in which the heart cannot pump out all of the blood that enters it, which leads to an accumulation of blood and fluid in the vessels and body tissues). Heart-related complications of rheumatic fever may take years to develop. 

What are the symptoms of rheumatic fever?

The symptoms of rheumatic fever usually start about one to five weeks after your child has been infected with 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 neuromuscular movements; (This is usually noted by a change in your child's handwriting and may also include unusual, jerky movements.)

• Rash (a pink rash with odd edges that is usually seen on the trunk of the body or arms and legs)

• Fever

• Weight loss

• Fatigue

• Chest discomfort 

• Shortness of breath 

• Stomach pains

The symptoms of rheumatic fever may resemble 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:

• Your child's overall health and medical history

• Extent of the disease

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

The best treatment for rheumatic heart disease is prevention. Antibiotics can usually 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.

If inflammation of the heart has developed, children may be placed on bed rest. Medications are given to reduce the inflammation, as well as antibiotics to treat the Streptococcus infection. Other medications may be necessary to handle congestive heart failure.

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