Rheumatic Heart Disease – Causes, Symptoms, Treatment

Rheumatic heart disease is permanent damage to one or more heart valves that can develop after rheumatic fever. It most often affects the mitral valve and may cause problems such as mitral stenosis, valve leakage, breathlessness and reduced ability to exercise.

If you have been told that you have rheumatic heart disease, the first thing to understand is that the name itself does not tell you how severe the valve problem is. Your echocardiogram, symptoms and the effect of the valve disease on your heart give a much clearer picture.

For some people, regular follow-up is enough. For others, the valve may become severely narrowed or leaky and require a procedure or valve replacement. Patients from countries such as Bangladesh and Nigeria may also travel to India when they need specialist assessment or valve care.

What Is Rheumatic Heart Disease?

Rheumatic heart disease is a condition in which the heart valves have been damaged following rheumatic fever.

Rheumatic fever can occur after an infection caused by Group A Streptococcus bacteria. The illness can cause inflammation in different parts of the body, including the heart. When the heart valves are affected, the inflammation can eventually leave behind scarring and structural changes.

You may not notice anything wrong with your heart at the time. The valve damage can develop slowly and become apparent years later.

This is one reason rheumatic heart disease can sometimes come as a surprise. You may have had rheumatic fever during childhood and only discover a valve problem much later when an echocardiogram shows narrowing or leakage.

The mitral valve is the valve most commonly affected. Rheumatic heart disease can also involve the aortic valve and, in few patients, more than one valve.

Research and echocardiographic recommendations describe characteristic rheumatic valve changes such as leaflet thickening, restricted movement and commissural fusion, with the mitral valve predominantly affected and mitral stenosis being a common consequence (Pandian et al., 2023).

What happens to the valve? With rheumatic valve damage, the valve can become thickened or scarred. It may not open properly, causing stenosis, or it may not close properly, causing regurgitation.

The result is that the heart has to work harder to move blood through the circulation. The effect depends on which valve is involved and how severe the damage has become.

What Causes Rheumatic Heart Disease?

The main cause of rheumatic heart disease is previous rheumatic fever.

Rheumatic fever can develop after certain Group A Streptococcus infections. In some people, the inflammation caused by rheumatic fever affects the heart valves.

The problem can become more significant when a person experiences repeated episodes of rheumatic fever. Each episode can contribute to further valve damage.

This is why preventing another episode of rheumatic fever is an important part of managing people who have already had rheumatic heart disease.

If you have a history of rheumatic fever but have never had a detailed heart evaluation, your doctor may recommend an echocardiogram to check the valves.

Which Heart Valve Is Usually Affected?

The mitral valve is most commonly affected in rheumatic heart disease.

This valve sits between the left atrium and left ventricle. When rheumatic damage causes the valve opening to become narrow, it is called rheumatic mitral stenosis.

Rheumatic Mitral Stenosis

In rheumatic mitral stenosis, the mitral valve becomes stiff and narrowed. Blood has more difficulty moving from the left atrium into the left ventricle.

As the narrowing becomes more severe, pressure can build up behind the valve and affect the blood vessels in the lungs.

Notice Breathlessness while walking, climbing stairs or doing other activities that were previously comfortable.

You may notice Some people also develop an irregular heart rhythm called atrial fibrillation. This can further affect blood flow and may increase the risk of blood clots.

Rheumatic Mitral Regurgitation

The mitral valve can also become unable to close properly. When this happens, some blood flows backward into the left atrium when the heart contracts.

The amount of leakage matters. A small amount may have little effect, while significant leakage can place increasing strain on the heart.

Aortic Valve Involvement

The aortic valve can also be affected by rheumatic disease. Depending on the changes in the valve, this may result in narrowing, leakage or a combination of valve abnormalities.

When more than one valve is affected, your doctor will assess the valves together to understand the overall effect on the heart.

What Symptoms Can Rheumatic Heart Disease Cause?

Rheumatic heart disease symptoms can vary widely. Some people have no symptoms when the valve disease is mild. Others may notice changes gradually as the valve problem becomes more significant.

This can also be confusing because the symptoms of rheumatic fever are not the same as the symptoms caused by lasting heart valve damage. Rheumatic fever may cause fever, joint pain and other signs of inflammation during the illness, while rheumatic heart disease symptoms can appear much later when a damaged valve starts affecting how the heart works. 

Common symptoms include:

• Breathlessness during physical activity
• Tiredness
• Reduced exercise tolerance
• Chest discomfort
• Palpitations
• Dizziness
• Swelling of the feet and ankles
• Breathlessness when lying down
• Shortness of breath that is getting worse over time

When symptoms start affecting your daily routine

You may notice that a walk that was once easy now leaves you short of breath.

You may need to stop halfway while climbing stairs. You may feel unusually tired by the end of the day. Or you may notice that your ankles are swelling more often.

These changes do not always mean that rheumatic heart disease is getting worse. Breathlessness and tiredness can have many causes.

But if you already have known valve disease, a change in your usual ability to walk or exercise is worth discussing with your cardiologist.

The severity of symptoms also does not always match the severity seen on an echocardiogram. This is why your doctor looks at your symptoms together with your valve findings and heart function.

How Is Rheumatic Heart Disease Diagnosed?

Your doctor will usually start with your medical history and examination. If rheumatic heart disease is suspected, an echocardiogram is central to the evaluation.

What the Echocardiogram Checks	What It Tells Your Doctor
Valve affected	Shows which heart valve has rheumatic changes.
Valve narrowing or leakage	Shows whether the valve is narrowed, leaking or both.
Valve leaflets	Shows changes in the thickness, movement and structure of the valve leaflets.
Heart chamber function	Shows how well the heart chambers are working and pumping blood.
Heart chamber size	Shows whether the chambers have become enlarged due to the valve problem.
Heart and lung pressures	Helps assess whether the valve disease has increased pressure inside the heart or lungs.

Echocardiography is considered the most important diagnostic tool for identifying rheumatic heart disease and assessing the severity of valve disease. It can also help doctors plan treatment and monitor changes over time (Pandian et al., 2023).

Other tests your doctor may recommend

Depending on your symptoms and valve condition, your evaluation may also include:

ECG

An electrocardiogram can identify an abnormal heart rhythm such as atrial fibrillation.

Chest X-ray

This may provide information about the heart and lungs when clinically required.

Blood tests

Blood tests may be recommended depending on your medical history and the question your doctor is trying to answer.

An ASO titre test may show evidence of a previous streptococcal infection, but an elevated ASO titre by itself does not conclude a diagnosis of rheumatic heart disease.

How Is Rheumatic Heart Disease Treated?

Rheumatic heart disease treatment depends on how much the valve has been affected and whether the condition is affecting your heart or causing symptoms.

Your doctor may recommend regular monitoring if the valve disease is mild. Medicines may be used to manage symptoms or specific complications. When valve damage becomes significant, a procedure may be considered.

Preventing another episode of rheumatic fever

People with a history of rheumatic fever may need long-term preventive treatment to reduce the risk of another episode.

The exact medicine and duration depend on your age, previous rheumatic fever history and individual clinical situation.

Preventing recurrent rheumatic fever is important because repeated episodes can contribute to further valve damage.

Medicines

Medicines do not remove established scarring from a damaged valve.

However, they may help manage problems caused by valve disease.

For example, medicines may be used to control fluid build-up, manage blood pressure or control an abnormal heart rhythm. Anticoagulant treatment may be needed for some patients with atrial fibrillation or certain types of artificial heart valves.

“With rheumatic heart disease, the valve is what we need to look at closely. Medicines can help manage the effects of a damaged valve, but they do not remove the narrowing or repair the valve itself. When the mitral valve becomes significantly narrowed, we assess its structure and movement on echocardiography to see whether the patient may benefit from balloon valvotomy or another valve treatment.”

— Dr. Gourish Shinde, M.B.B.S., M.D. (Anaesthesia), D.M. (Cardiac Anaesthesia)
Consultant Cardiac Anaesthetist and Interventional Imager, Mumbai

Balloon procedures

Some patients with significant rheumatic mitral stenosis may be suitable for a catheter-based procedure called percutaneous mitral balloon valvotomy.

A balloon is passed through a catheter to the narrowed mitral valve and inflated to improve the opening.

Whether this is suitable depends on the valve anatomy, the severity of stenosis, the presence of other valve problems and other findings on the echocardiogram.

Valve repair or replacement

When a valve is severely damaged, your heart valve team may discuss valve repair or replacement.

The choice depends on the valve involved, the type of damage, the anatomy of the valve and your overall health.

For some patients, preserving the patient’s own valve through repair may be possible. For others, replacement may provide a more appropriate long-term solution.

If a mechanical valve is used, lifelong warfarin treatment and regular INR monitoring are generally required.

When Does Rheumatic Heart Disease Need Valve Treatment?

Not everyone with rheumatic heart disease needs a valve procedure.

Your doctor looks at several findings before recommending intervention.

What Determines Your Valve Treatment? Your treatment decision depends on the severity of valve narrowing or leakage, your symptoms, heart chamber size, heart pumping function, pressure in the lungs, heart rhythm, valve anatomy, whether more than one valve is affected, and your age and overall health.

For example, a person with mild rheumatic mitral stenosis and no symptoms may simply need regular follow-up.

A person with severe mitral stenosis, increasing breathlessness and rising pressure in the lungs may need a more detailed assessment for valve surgery and further intervention.

The important point is that the decision comes from the whole picture, not simply the words “rheumatic heart disease” on a report.

Can Rheumatic Heart Disease Get Worse Over Time?

It can. The course varies from person to person. Some patients remain stable for a long period, while others develop progressive valve damage.

Global research found that most definite rheumatic heart disease cases remained stable during follow-up, while a smaller proportion progressed, showing why ongoing assessment remains important (Noubiap et al., 2019).

Another long-term study of rheumatic heart disease found that some definite cases persisted or progressed to more severe disease, with some patients eventually requiring valve surgery (Engelman et al., 2016).

The risk is influenced by the type and severity of valve disease, previous episodes of rheumatic fever and other health conditions.

This is why follow-up matters even when you feel well.

Your doctor may compare one echocardiogram with the next to see whether the valve has changed and whether the heart chambers are responding differently.

So if your doctor has asked you to repeat an echocardiogram after a certain period, the purpose is not simply to check the valve again. The comparison helps show whether anything has changed.

Travelling to India for Rheumatic Heart Disease Treatment

If you have significant rheumatic valve disease and need specialist care, you may consider travelling to India for evaluation and treatment.

This can be particularly relevant for patients from Bangladesh and Nigeria who are looking for specialist heart valve care.

Before travelling, it is useful to collect your existing medical records. Your treating team can review these reports and understand your condition before you arrive.

What Should You Carry for Your Valve Consultation? Recent echocardiogram reports, echocardiogram images if available, ECG reports, blood test results, previous hospital discharge summaries, current medicines, previous rheumatic fever records, previous valve procedure records, INR reports if you are taking warfarin, and details of any previous valve replacement.

If your valve problem is already known, previous echocardiograms are particularly useful because your doctor can compare the older and newer findings.

Rheumatic Heart Disease Treatment in India for Patients From Bangladesh

For a patient travelling from Bangladesh, the first step is usually a review of the existing medical information.

The heart team can then determine whether you need another echocardiogram, a detailed valve assessment, continued monitoring or a valve procedure.

If you have rheumatic heart disease in Bangladesh and have been advised to consider valve treatment, bringing your previous reports can make the specialist consultation more useful.

Rheumatic Heart Disease Treatment in India for Patients From Nigeria

Patients with rheumatic heart disease in Nigeria may also travel to India when specialist valve assessment or treatment is required.

The same principle applies. Your treatment is based on the condition of your valve and heart, not simply where you are travelling from.

Sharing your reports before the visit can help the cardiac team understand your previous diagnosis and the treatment already received.

Expert Insight “When patients come to us from another country, they often arrive with many reports and are unsure about what they actually need. I first look at their previous echocardiograms, symptoms and treatment history to understand how the valve problem has changed. This helps us explain the condition clearly and decide whether the patient needs monitoring, further evaluation or a valve procedure.” Dr. Harshad Uttamrao Sagar, M.B.B.S., DNB (General Medicine), DrNB (Cardiology) Interventional Cardiologist, HVS Symbiosis Hospital, Mumbai

When Should You See a Heart Valve Expert?

If you have been diagnosed with rheumatic heart disease and your symptoms are increasing, your echocardiogram shows significant valve disease or your doctor has started discussing a valve procedure, an expert valve assessment can help you understand your options.

Bring your previous echocardiograms and reports to the consultation. Looking at how the valve and heart have changed over time can help a Heart Valve Expert understand your condition better than looking at the latest scan alone.

At Heart Valve Experts, your previous reports, symptoms and current valve findings can be reviewed together to understand whether you need continued monitoring or further valve treatment.

Frequently Asked Questions

What is rheumatic heart disease?

Rheumatic heart disease is long-term damage to the heart valves caused by rheumatic fever. The mitral valve is most commonly affected.

What causes rheumatic heart disease?

Rheumatic heart disease develops after rheumatic fever, which can occur following certain Group A Streptococcus infections. The inflammation can damage the heart valves and leave lasting scarring.

What are the symptoms of rheumatic heart disease?

Common rheumatic heart disease symptoms include breathlessness, fatigue, reduced exercise tolerance, chest discomfort, palpitations and swelling of the legs or ankles. Some people may have no symptoms when the valve disease is mild.

What is rheumatic mitral stenosis?

Rheumatic mitral stenosis is narrowing of the mitral valve caused by rheumatic valve damage. The narrowed valve makes it harder for blood to move from the left atrium into the left ventricle.

Can rheumatic heart disease be treated?

Yes. Rheumatic heart disease treatment may include prevention of recurrent rheumatic fever, medicines, regular echocardiographic monitoring and valve procedures when the valve disease becomes significant.

Does rheumatic heart disease always require valve replacement?

No. Some people only need regular monitoring or medicines. Depending on the valve involved and the type of damage, some patients may be suitable for balloon valvotomy or valve repair, while others may need valve replacement.

Can rheumatic heart disease get worse with time?

Yes. Valve damage can progress in some patients. Regular follow-up helps your doctor compare echocardiograms and identify changes in valve function or heart size.

Can patients from Bangladesh travel to India for rheumatic heart disease treatment?

Yes. Patients from Bangladesh can travel to India for specialist evaluation and valve treatment. Existing echocardiograms, ECGs, blood tests and previous treatment records should be carried for review.

Can patients from Nigeria travel to India for rheumatic heart disease treatment?

Yes. Patients from Nigeria can seek specialist valve assessment and treatment in India. The treatment plan depends on the severity and type of valve disease and the patient’s overall health.

What test is used to diagnose rheumatic heart disease?

An echocardiogram is the main imaging test used to identify rheumatic valve changes and assess their severity. Other tests such as an ECG and blood tests may be used depending on the patient’s history and symptoms.

References

Pandian, N.G., Kim, J.K., Arias-Godinez, J.A., Marx, G.R., Michelena, H.I., Mohan, J.C., Ogunyankin, K.O., Ronderos, R.E., Sade, L.E., Sadeghpour, A., Sengupta, S.P., Siegel, R.J., Shu, X., Soesanto, A.M., Sugeng, L., Venkateshvaran, A., Vieira, M.L.C. and Little, S.H. (2023). Recommendations for the Use of Echocardiography in the Evaluation of Rheumatic Heart Disease: A Report from the American Society of Echocardiography. Journal of the American Society of Echocardiography, 36(1), pp.3–28.

Noubiap, J.J., Agbor, V.N., Bigna, J.J., Kaze, A.D., Nyaga, U.F. and Mayosi, B.M. (2019). Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies. Scientific Reports, 9, 17022.

Engelman, D., Wheaton, G.R., Mataika, R.L., Kado, J.H., Colquhoun, S.M., Remenyi, B. and Steer, A.C. (2016). Screening-detected rheumatic heart disease can progress to severe disease. Heart Asia, 8(2), pp.67–73.