Rheumatic Fever and Rheumatic Heart Disease: Causes, Symptoms, and Treatment

Rheumatic Fever: The Trigger

Rheumatic fever (RF) is an autoimmune inflammatory reaction to Group A Streptococcus (GAS) pharyngitis (strep throat). It typically occurs 2–4 weeks after untreated or inadequately treated infection. Most common in children 5–15 years old.

Jones Criteria (Diagnosis)

Major criteria: Carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules.
Minor criteria: Fever, arthralgia, elevated ESR/CRP, prolonged PR interval.
Diagnosis: 2 major, or 1 major + 2 minor + evidence of recent GAS infection.

Rheumatic Heart Disease (RHD): The Complication

RF causes inflammation of all heart layers (pancarditis). The valves are most vulnerable:

• Mitral valve (most common): Regurgitation → stenosis over years.
• Aortic valve: Regurgitation.
• Tricuspid/pulmonary: Less common.

Regurgitation: Valve doesn't close fully → backward flow.
Stenosis: Valve thickens, fuses, narrows → obstructs forward flow.

Symptoms of RHD

• Shortness of breath (exertional → at rest)
• Fatigue, exercise intolerance
• Chest pain
• Palpitations (atrial fibrillation common in mitral stenosis)
• Peripheral edema, ascites (right heart failure)
• Hemoptysis (mitral stenosis)

Complications

• Heart failure
• Atrial fibrillation → stroke risk
• Infective endocarditis
• Pulmonary hypertension
• Pregnancy complications

Treatment

Acute RF

• Penicillin (or erythromycin if allergic) to eradicate GAS.
• Anti-inflammatories: Aspirin (high-dose) or naproxen for arthritis/carditis.
• Corticosteroids (prednisone) for severe carditis.

Chronic RHD

• Secondary prophylaxis: Benzathine penicillin G IM every 3–4 weeks (duration: 10 years after last episode or until age 21, whichever longer; lifelong if valve damage).
• Heart failure management: Diuretics, ACE inhibitors, beta-blockers.
• Anticoagulation: For atrial fibrillation or mechanical valves.
• Valve intervention: Balloon valvuloplasty (mitral stenosis) or surgical repair/replacement.

Prevention Is Paramount

Treat all GAS pharyngitis with 10 days of penicillin (or amoxicillin). This prevents RF and RHD entirely. Public health strategies: school screening, penicillin access, health education.