Rheumatic Fever and the Heart

What is rheumatic fever?

Rheumatic fever is a disease caused by a reaction to streptococcus bacteria, the same germ that causes Strep throat.

How does it occur?

Rheumatic fever causes an over-reaction of the immune system. The immune system is your body's defense against infection. In attacking the Strep germ, some body tissues are attacked as well. Rheumatic fever can affect the heart, the joints, the skin, and the nervous system. Heart problems may show up right away or may appear many years after the original infection. Rheumatic fever often affects the joints of the legs first. In some cases, only the heart tissues may be affected.

Most people with strep throat do not get rheumatic fever. You are more at risk for rheumatic fever if you have had several Strep infections.

What are the symptoms?

The symptoms usually begin 1 to 6 weeks after a sore throat. There is often swelling and pain in the large joints of the body (knees, ankles, elbows, and wrists). The symptoms may move from joint to joint. Some people develop uncontrollable twitches or movements of muscles in the face, arms, and legs. The medical name for these movements is chorea, but it is commonly known as St. Vitus' dance. The twitches and joint pains usually disappear after a few weeks without any long-term damage.

A few people may develop pink or light red nonitching blotches or small bumps under the skin on their elbows or knees. Almost all people with rheumatic fever will have some fever and feel tired and achy. Some may have abdominal pain. Rheumatic fever usually gets better after a few weeks.

The biggest problem caused by rheumatic fever is low-level inflammation of the heart valves. This may continue for many years and scar the heart valves. Over time, the heart valves may have trouble opening or closing properly. One valve or several valves may be affected. Eventually, the valve may need to be repaired with surgery.

The heart muscle cells may be weakened, which affects the heart's ability to pump. The tissue sack that surrounds and protects the heart may be inflamed (pericarditis). Pericarditis usually causes chest pain. Rarely, it can cause fluid to build up around the heart. The pressure caused by this fluid may interfere with the heart's ability to pump blood.

Rheumatic fever can interfere with the electrical signals in the heart, temporarily causing the heart to beat too slowly.

How is it diagnosed?

Your healthcare provider will ask about your symptoms, and whether you have had a sore throat recently. He or she will examine your joints and will look for skin rashes and the small bumps under your skin.

You will probably have a blood test to check for antibodies to the streptococcus germs. A record of your heart's activity, called an electrocardiogram, may show changes from the normal pattern. An ultrasound test, called an echocardiogram, may help diagnose valve problems.

How is it treated?

Your healthcare provider may recommend bed rest until you no longer have a fever. You will probably need an antibiotic to kill any streptococcus germs still present. You may need monthly injections to prevent future Strep infections. Aspirin or other drugs may be given to relieve symptoms, but they don't cure the disease. The jerky movements of chorea are sometimes treated with sedatives or tranquilizers.

Treatment of rheumatic heart disease involves treating the damaged heart valves. Most often the valve leak problem caused by the disease is mild and does not need treatment. The most common problem caused by rheumatic heart disease is trouble with one of the valves opening all the way. This problem is called mitral stenosis. Mitral stenosis can often be treated with balloon surgery that doesn't involve opening the chest. Sometimes the valve is too badly damaged to repair, in which case it must be replaced by an artificial valve. Problems with other valves or problems with valve leakage can't be fixed with balloon surgery. When these valve problems are severe, replacement with an artificial valve will be needed.

The symptoms of joint inflammation and pain, rash, uncontrollable twitches, and bumps under the skin usually disappear and cause no permanent problem. When the heart muscle is affected, it usually recovers. However, heart valve damage may appear years later.

It is very important to keep from getting rheumatic fever again. Repeated infections increase the chances of permanent heart damage.

What can I do to stay healthy?

Follow your healthcare provider's instructions. Report any further sore throats. You may need to take an antibiotic regularly for months or years to prevent infection. You may also need to take antibiotics before having dental work or surgery. Follow your healthcare provider's advice about physical activity.