What is Rheumatic Heart Disease?
Rheumatic heart disease (RHD) is a serious disease of the heart involving damage to one or more of the four small heart valves. The valve damage remains after an illness called acute rheumatic fever (ARF). During ARF the heart valve tissue, and sometimes other parts of the heart (the heart lining or muscle) can become swollen, and this is called carditis. Following carditis, the heart valves can remain damaged then become scarred, and the result is an interruption to normal blood flow through the damaged valves. Some blood may flow backward through a leaky valve that does not close properly, or blood may be blocked because a tight, scarred valve does not open properly. When the heart is damaged in this way, the heart valve is not able to function adequately, and heart surgery may be required to repair or replace the damaged valve. Regular antibiotics are prescribed for people with RHD to prevent recurrent ARF and subsequent worsening of the valve damage.1
Rheumatic heart disease is a chronic, disabling and sometimes fatal disease that is entirely preventable.
What are the symptoms of rheumatic heart disease?
RHD is diagnosed by echocardiogram (ultrasound).2 Symptoms of mild RHD may not be noticed for many years.3 When they do develop, symptoms usually depend on which heart valves are affected, and the type and severity of the damage. Many people with RHD have a heart murmur, which can be heard through a stethoscope. Symptoms of more severe disease can include chest pain, breathlessness with physical activity or when lying down, weakness and tiredness, and swelling of the legs.
More than half of those with ARF progress to RHD within 10 years of their initial ARF episode, and more than one-third of these people develop severe RHD.4 With severe RHD there is a risk of abnormal heart rhythms, stroke, endocarditis, and complications during pregnancy.3 These complications cause progressive disability, reduce quality of life, and can lead to premature death in young adults. Heart surgery can manage some of these problems and prolong life, but does not cure RHD. Close monitoring with regular echocardiography can help to determine optimal timing and type of surgery. Medical care focuses on managing RHD with medications to control the symptoms, antibiotics to prevent Strep A infection, holistic management including dental and pregnancy care, and promoting a healthy lifestyle.1
Who is at risk?
People who have one or more episodes of ARF with carditis are at risk of developing RHD, The following population groups in Australia at high risk of ARF.1
- Aboriginal and Torres Strait Islander peoples, particularly those living in rural or remote settings across central and northern Australia, are known to be at very high risk.
- Aboriginal and Torres Strait Islander peoples living in urban settings, particularly where there is household crowding, are also at high risk.
- Māori and Pacific Islander peoples, particularly where there is household crowding, are also at high risk.
- RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition). 2020
- Reményi B, Wilson N, Steer A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease—an evidence-based guideline. Nature Review Cardiology. 2012;9:297-309.
- Zühlke L, Karthikeyan G, Engel ME, et al. Clinical Outcomes in 3343 Children and Adults with Rheumatic Heart Disease From 14 Low- and Middle-Income Countries: Two-Year Follow-Up of the Global Rheumatic Heart Disease Registry (the REMEDY Study). Circulation. 2016;134(19):1456-1466.
- He VYF, Condon JR, Ralph AP, et al. Long-term outcomes from acute rheumatic fever and rheumatic heart disease: A data-linkage and survival analysis approach. Circulation. 2016;134:222-232.
LAST UPDATED 12 JUNE 2020