Rheumatic Heart Disease in Children

What is Rheumatic Heart Disease?

Rheumatic heart disease (RHD) is an autoimmune disorder that affects children and young adults.

It occurs when the body’s immune system mistakenly attacks the heart’s tissue, leading to inflammation and eventual damage of the heart valve, muscles, or other structures.

RHD can lead to severe complications such as congestive heart failure, arrhythmias, and even death.

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What causes Rheumatic Heart Disease?  

Rheumatic heart disease is a long-term complication of untreated streptococcal infections, including those that cause strep throat and scarlet fever.  It occurs when the body’s immune system turns on itself and begins to attack the heart muscle.  This process can lead to the following:  

  • Narrowing of the heart valves 
  • Damage to the inner lining of the heart valves 
  • Formation of scar tissue

Signs & Symptoms

Rheumatic heart disease in children is typically marked by several signs and symptoms, including: 

  • Arrhythmias (abnormal heart rhythms) or palpitations (the sensation that the heart is racing or skipping beats) 
  • Chest pain or discomfort when breathing
  • Difficulty breathing/shortness of breath 
  • Fever 
  • Heart murmurs (unusual sounds heard during a physical exam) 
  • Joint pain and inflammation (especially in the wrists, elbows, knees, ankles, and hips)
  • Stiffness or limited range of motion in the joints 
  • Swelling in the legs, feet, and abdomen 
  • Tenderness of the joints 
  • Weakness, fatigue, and lack of energy 

A dad with his daughterRisk Factors

Risk factors for rheumatic heart disease in children include: 

  • Age  
  • Children who live in tropical climates 
  • Family history of rheumatic heart disease 
  • Gender 
  • Genetics 
  • Lack of immunization against group A streptococcal infections
  • Living conditions 
  • Limited access to healthcare 
  • Overcrowded and unsanitary 
  • Poverty  
  • Underlying health conditions (diabetes, obesity)  


Rheumatic heart disease is usually diagnosed through physical examination, history taking, laboratory tests, and imaging studies.  

Physical exam typically includes:  

  • An evaluation of the size and shape of the heart 
  • Checking for signs of infection, such as fever 
  • Enlarged lymph nodes  
  • Listening for any murmurs or irregular rhythms 
  • Looking for evidence of damaged valves or other cardiac abnormalities.  
  • Rash 

Laboratory tests may include blood and urine tests to check for signs of infection, such as an elevated white blood cell count and higher-than-normal levels of antibodies that indicate an active autoimmune disorder.  

Imaging studies, such as a chest X-ray or echocardiogram, can visualize the heart, evaluate its structure and function, and detect any abnormalities.  



Rheumatic heart disease can be treated with penicillin, aspirin, and other anti-inflammatory drugs.

Regular checkups are essential for monitoring the progress of treatment.

Surgery may also be necessary to repair or replace damaged valves.

In addition, lifestyle changes such as limiting activity and avoiding overexertion, avoiding contact sports, and not getting infections can help reduce the risk of further damage or complications.

In extreme cases, a heart transplant may be needed.

Children with rheumatic heart disease need to receive ongoing medical care from a doctor who specializes in treating this condition. In addition, doctors will typically recommend that these children have regular checkups, appropriate medical treatments, and lifestyle changes.


Rheumatic heart disease is preventable and can be prevented in children through regular vaccination against streptococcal bacteria with the pneumococcal conjugate vaccine (PCV).

Additionally, appropriate diagnosis and treatment of strep throat infections are essential to prevent the future development of rheumatic heart disease.

Other measures that can help prevent the condition include handwashing practices, using clean drinking water, and avoiding overcrowding.

CHRISTUS Children's - The Heart Center

CHRISTUS Children's specializes in pediatric care for infants, children and adolescents as well as maternal and fetal care for women with high-risk and routine pregnancies. From birth to age 18, CHRISTUS Children’s provides comprehensive, coordinated care from a team of pediatric and maternal experts.

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