Rheumatic Fever

Before antibiotic medicines became widely used, rheumatic fever was the single biggest cause of valve disease

Rheumatic fever is a complication of untreated strep throat (caused by a group A streptococcal infection).

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 or close properly, causing your heart to work harder pumping 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” (called leaflets or cusps).

Who is at risk for this fever?

Fewer than 0.3% of people who have strep throat also get rheumatic fever. This 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 the fever in developed countries, there are still thousands of reported cases.

What are the symptoms of rheumatic fever and how is it diagnosed?

Symptoms of rheumatic fever usually begin 1 to 6 weeks after you have had a strep infection. They are

  • Fever
  • 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

Your doctor will begin by doing a throat culture to find out if you have a strep infection.

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 this 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. Even 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 get tested. 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.

Lifestyle Changes

If this type of 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.

Surgical Procedures

In some patients, rheumatic fever damages a heart valve. In these cases, your doctor may recommend surgery to repair or replace the damaged valve.