Related terms: valve disease, strep throat, streptococcal infection
Before antibiotic medicines became widely used, rheumatic fever was the single biggest cause of valve disease. Rheumatic fever is a condition that is a complication of untreated strep throat. Strep throat is caused by a group A streptococcal infection found in the throat.
Rheumatic fever can damage body tissues by causing them to swell, but its greatest danger lies in the damage it can do to your heart. More than half of the time, rheumatic fever leads to scarring of the heart's valves. This scarring can narrow the valve and make it harder for the valve to open properly or to close completely. In turn, your heart has to work harder to pump blood to the rest of your body. This valve damage can lead to a condition called rheumatic heart disease, which, in time, can lead to congestive heart failure.
What causes rheumatic fever?
Rheumatic fever is not an infection itself, but rather the result of an untreated strep infection. When your body senses the strep infection, it sends antibodies to fight it. Sometimes, these antibodies attack the tissues of your joints or heart instead. If the antibodies attack your heart, they can cause your heart valves to swell, which can lead to scarring of the valve "doors." (The doors are called leaflets.) The scarred leaflets make it harder for the valve to either open or close properly, or both.
Who is at risk for rheumatic fever?
Fewer than 0.3% of people who have strep throat also get rheumatic fever. Rheumatic fever is most common among children aged 5 to 15, but adults may have the condition as well. Doctors think that a weakened immune system may make some people more likely to get rheumatic fever. And, although antibiotic medicines have reduced the number of cases of rheumatic fever in developed countries, there are still thousands of reported cases.
What are the symptoms of rheumatic fever?
The symptoms of rheumatic fever usually begin 1 to 6 weeks after you have had a strep infection. The symptoms are
- Joint pain or swelling in your wrists, elbows, knees, or ankles.
- Small bumps under the skin over your elbows or knees (called nodules).
- A raised, red rash on your chest, back, or stomach.
- Stomach pain or feeling less hungry.
- Weakness, shortness of breath, or feeling very tired.
How is rheumatic fever diagnosed?
Your doctor will begin by doing a throat culture to find out if you have a strep infection. To test for strep throat, he or she will run a cotton swab over the back of your throat. The bacteria collected on the end of the swab are placed on what is called a culture, which lets the bacteria grow so that they can be analyzed.
Then, your doctor will use a stethoscope to listen to your heart. He or she will also look for nodules on your joints. Sometimes, blood tests, chest x-rays, or an electrocardiogram (ECG or EKG) may be needed for a more definite diagnosis.
How is rheumatic fever treated?
Rheumatic fever must be treated right away. If you have a sore throat that lasts longer than 3 days, or if you have a fever and headache along with your sore throat, you should see your doctor for a throat culture. If you do not have a sore throat but have a fever and a skin rash, this could also mean a strep infection, and you should see your doctor right away. Remember rheumatic fever can result from an untreated strep infection, so it is very important to treat the infection before it leads to a worse condition.
If rheumatic fever has led to rheumatic heart disease or damage to your heart valves, your doctor may recommend that you take antibiotic medicines continuously for many years. Some patients with rheumatic fever need to take antibiotics for the rest of their lives. In any case, you should always tell your doctor or dentist about your history of rheumatic fever before you have a surgical or dental procedure. Such procedures may cause bacteria to enter the bloodstream and infect your heart valves.
If your doctor tells you that you have a strep infection, he or she will prescribe an antibiotic medicine. It is important that you take the medicine when and how your doctor tells you. Do not stop taking the medicine just because you start to feel better. Many people find that they feel better after a couple of days of therapy, so they stop taking their medicine. Even if your sore throat does not come back, without the antibiotics in your bloodstream, the streptococcal bacteria can still multiply and affect your heart and other organs.
If your strep infection leads to rheumatic fever, your doctor may prescribe anti-inflammatory medicines or aspirin to reduce the swelling in your body's tissues. Sometimes, patients need to take a diuretic to help rid their body of excess water and salt. How long you take them depends on how old you are, how many attacks you have had, and how severe your symptoms are.
In some patients, rheumatic fever damages a heart valve. In these cases, your doctor may recommend surgery to repair or replace the damaged valve.
See also on this site: Valve Disease
See on other sites:
American Heart Association
What About My Child and Rheumatic Fever? (downloadable PDF)
Updated October 2013