Rheumatic Heart Disease: How the Heart Is Affected and What Symptoms Occur

Rheumatic heart disease is not a separate infection but a delayed response of the immune system to streptococcal tonsillitis or scarlet fever, in which inflammation affects the linings of the heart. Let us walk through the mechanism step by step, and then look at how it presents in adults and children and how doctors make the diagnosis.

What rheumatic heart disease is and how it relates to rheumatic fever

In the international literature, the term "rheumatism" has been replaced by the concept of "acute rheumatic fever" — a systemic inflammation of connective tissue with predominant localization in the linings of the heart. It is triggered not by the bacterium itself but by the immune system: while fighting group A streptococcus, it attacks healthy tissues. Imagine a guard chasing a thief through a house and starting to smash the furniture — the damage he causes is no less than the burglar's. Rheumatic fever develops after tonsillitis or scarlet fever: usually 1–5 weeks after tonsillitis or scarlet fever. It mainly affects children aged 5–15 years; most people who have had the infection do not develop rheumatic fever, and susceptibility is linked to genes.

How the heart is affected in rheumatic disease

The cardiac form — rheumatic carditis — involves all the linings of the heart, but primarily the myocardium. Inflammation of the valves with the formation of murmurs, damage to the heart muscle and pericardium are possible. It is the valvular damage that leaves a long-term trace: the leaflets may leak blood or narrow the opening. Such rheumatic heart involvement can manifest years later, so regular check-ups are needed after an episode.

Symptoms of rheumatic heart disease in adults

The picture consists of intoxication and cardiac signs: weakness, sweating, decreased appetite, temperature above 38 °C, pulling or stabbing pain in the heart area, tachycardia. The doctor may hear a muffled first heart sound, a gallop rhythm, a systolic or diastolic murmur. Signs of heart failure may be added. The joint form causes pain, swelling, redness and heat in the knees, elbows, ankles and wrists, sometimes migrating from joint to joint.

Rheumatic heart disease in children: how the picture differs

In children, rheumatic chorea — "St. Vitus' dance" — is more common: rapid uncontrolled movements of the face, hands and feet, grimacing, changes in handwriting, emotional instability; the symptoms disappear during sleep. An annular rash on the trunk, subcutaneous nodules, nosebleeds, and abdominal pain are possible. Cardiac manifestations in a child may cause no complaints at all.

How rheumatic heart involvement is diagnosed

The doctor examines the skin and joints and auscultates the heart. Tests include a complete blood count, ESR, C-reactive protein, a test for past streptococcal infection (ASO) and an ECG. The diagnosis relies on major criteria (arthritis of large joints, heart inflammation, nodules, chorea, rash) and minor criteria (fever, elevated ESR, joint pain, ECG changes): two major criteria or one major and two minor criteria together with evidence of recent streptococcal infection are sufficient.

• Major criteria: polyarthritis, carditis, nodules, chorea, annular rash.
• Minor criteria: fever, elevated ESR, arthralgia, ECG changes.
• Streptococcal confirmation: ASO test.
• Instrumental methods: ECG.

What complications are possible and when to see a doctor

Long-term consequences include valve damage with leakage or narrowing, damage to the heart muscle, heart failure, endocarditis, pericarditis, unstable rhythm, chorea. You should see a doctor if tonsillitis occurs after a previous episode of rheumatic fever or if the previous symptoms return, as well as with recent streptococcal infection accompanied by signs of rheumatic disease.

On its own, it is not a reason to call an ambulance; 103 or 112 — for chest pain, severe shortness of breath and rapid heartbeat.

This overview is about the mechanism and reference points, not about making a diagnosis: the final word belongs to the doctor, who will examine the heart and order the necessary tests.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer