Rheumatic Heart Disease

What is rheumatic heart disease?

Rheumatic (pronounced roo-MAT-ik) heart disease is a condition in which the heart was damaged by rheumatic fever. Typically, this long-term damage occurs to the mitral valveaortic valve or both. This damage may cause the valve to “leak” or become narrowed over time.

Usually, the symptoms of rheumatic heart disease show up 10 to 20 years after the original illness. The mitral valve (between the left atrium and left ventricle) is usually more affected than the aortic valve (between the left ventricle and aorta).

Rheumatic heart disease can be prevented by preventing rheumatic fever.

  • Rheumatic fever is an inflammatory disease that sometimes happens after an infection caused by a bacteria called group A streptococcus, like strep throat or scarlet fever. Rheumatic fever happens when the infection is not completely treated with medicine (antibiotics). It may affect the heart, joints, skin and brain.

    Symptoms of rheumatic fever may include: 

    • Fever
    • Joint swelling, tenderness, redness over multiple joints
    • Small bumps or nodules under the skin
    • Rash
    • Weight loss
    • Fatigue
    • Stomach pain 

    Rheumatic fever may cause serious, permanent damage to the valves of the heart. Most often, it damages the mitral valve, aortic valve or both. These valves act like doors in the heart that allow blood to pass between or out of the chambers on the left side of the heart. If the valves are damaged by rheumatic fever, they may not be able to open fully. This causes a narrowing of the valve (stenosis), or the valves may not be able to close fully, resulting in a “leak” or not enough blood supply.

    Damage to the valves from rheumatic fever is known as valvulitis, meaning inflammation of the valve flaps (leaflets).

    Rheumatic fever may also affect the heart muscle, a condition known as myocarditis (inflammation of the heart muscle), or the outer covering (membrane) of the heart, a condition known as pericarditis.

    Rheumatic fever is the leading cause of valve disease that occurs after birth (acquired valve disease) in the world, but rheumatic fever is not very common in the United States.

    Doctors can prevent rheumatic fever from happening by treating the strep throat with medicine (antibiotics).

  • Children ages 5 to 15 years are at risk for rheumatic fever, particularly if they have frequent strep throat infections. Rheumatic fever is also more common in children who have a family history of rheumatic heart disease or rheumatic fever. Fewer than 1 out of 300 people who have strep throat also get rheumatic fever.

Rheumatic Heart Disease at Seattle Children’s


  • Our Heart Center is the top-ranked cardiology and cardiac surgery program in the Northwest and among the best in the nation, according to U.S. News & World Report. With more than 40 pediatric cardiologists, we have experience diagnosing and treating every kind of heart problem.

    We have extensive experience with the treatment of children and adolescents with rheumatic fever or rheumatic heart disease. We have a team of pediatric cardiac surgeons who are experienced in treating valves with stenosis or insufficiency. We also have a pediatric cardiac anesthesia teamCardiac Intensive Care Unit and experts in pediatric infectious diseases ready to care for children with this condition.

    Seattle Children’s has been treating children since 1907. Our team members are experts in their fields and in meeting the unique needs of children. For example, the doctors who give your child anesthesia (sedation) are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age.

  • When you come to Seattle Children’s, a team of people will take care of your child. Along with your child’s heart doctor (cardiologist), you are connected with a full range of pediatric subspecialists, nurses, child life specialists, social workers and others, if their help is needed.

    We work together to meet all of your child’s health needs and help your family through this experience. We’ll discuss treatments in ways you can understand and involve you in every decision.

    Read more about the supportive care we offer.

Symptoms of Rheumatic Heart Disease

Children with rheumatic heart disease may not have any clear symptoms.

If your child has aortic or mitral valve abnormalities due to rheumatic fever, they may have symptoms related to these valve problems. Some symptoms that may suggest a problem with these valves include being short of breath, particularly with activity or when lying down.

Children with myocarditis or pericarditis may have chest pain or swelling.

Your child may also have other effects of rheumatic fever, like joint pain and inflammation

Diagnosing Rheumatic Heart Disease

To diagnose this condition, your doctor will ask about any recent strep infections (strep throat) or sore throat episodes, examine your child and use a stethoscope to listen to their heart. In children with rheumatic heart disease, doctors can often hear a heart murmur.

During the exam, your child’s doctor will look for signs of inflammation in your child’s joints.

The doctor will ask for details about your child’s symptoms, their health history and your family health history. Your doctor may order a throat culture or a blood test to check for strep throat or signs of a recent strep infection, as well as performing other blood tests.

Your child will also need tests that provide information about how their heart looks and works. These may include: 

Treating Rheumatic Heart Disease

Rheumatic fever requires treatment with medicine (antibiotics). After initial treatment, preventative medicines (prophylactic antibiotics) are needed to make sure the strep infection doesn’t come back. Your doctor may also prescribe anti-inflammatory medicine to treat the joint pain and swelling. Bed rest may be recommended, and this can range from 2 to 12 weeks, depending on the seriousness of the illness.

If diagnosed with rheumatic fever, your child will need follow-up care with a heart doctor (pediatric cardiologist) to check for long-term damage to the heart (rheumatic heart disease).

Treatment for rheumatic heart disease

Once a child gets rheumatic heart disease from a strep infection, they may have to take medicine (antibiotics) for decades to prevent a return of rheumatic fever that can cause more damage to their heart valves.

If your child has a damaged heart valve that is narrow or leaks enough blood to strain their heart, they may need surgery to repair or replace the valve. Sometimes, if the valve is too narrow, a balloon catheter procedure (balloon valvuloplasty) may be used to try to open the valve without surgery. However, in many cases, the valve cannot be opened with a balloon procedure, and a child needs surgery to replace their valve with an artificial one.

Contact Us 

Contact the Heart Center at 206-987-2515 to request an appointment, a second opinion or more information.

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