Quick answer. Rheumatic heart disease (RHD) is permanent damage to the heart valves caused by rheumatic fever – an abnormal immune reaction that can follow an untreated or inadequately treated “strep” throat (a Streptococcus bacterial throat infection), usually in childhood. While fighting the bacteria, the immune system mistakenly attacks the body’s own tissues, including the heart valves, leaving them scarred, stiff or leaky years later. It most often damages the mitral and aortic valves. Thanks to widespread antibiotic treatment of throat infections, RHD is now uncommon in developed settings like Singapore, but it remains a major global problem and can still be seen in older adults and people who grew up in higher-risk regions.
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Rheumatic heart disease is largely a preventable condition, which is why it has become rare where strep throat is routinely treated. Its story – from a sore throat to damaged heart valves – is a reminder of why prompt treatment matters.
What it is
Rheumatic heart disease is lasting damage to the heart valves caused by rheumatic fever – an illness that can follow an untreated strep throat infection. In rheumatic fever, the immune system, while fighting the throat bacteria, mistakenly attacks the body’s own tissues, including the heart. The heart valves take much of the harm. Over time the affected valves become scarred and thickened, so they either fail to open fully (stenosis, a narrowed valve) or fail to close properly (regurgitation, a leaky valve), and sometimes both together. Because the valves keep blood flowing in the right direction with each heartbeat, this damage forces the heart to work harder and, over the years, can wear it down. The mitral valve is the one most often affected, with the aortic valve next.
The chain of events
The condition follows a recognisable chain. It begins with a “strep” throat – a sore throat caused by group A Streptococcus bacteria. In some people, if that infection is not treated, the body mounts an abnormal immune response called rheumatic fever in the weeks that follow. Acute rheumatic fever can bring on fever, painful and swollen joints, skin changes and inflammation of the heart. Rheumatic fever can then damage the heart valves, and this valve damage – rheumatic heart disease – may only become apparent much later, sometimes years after the original sore throat. A single episode of rheumatic fever can leave a mark, and repeated attacks add further damage. This whole sequence explains why treating strep throat promptly, and preventing repeat episodes of rheumatic fever in anyone who has already had it, matters so much: each link in the chain is a chance to stop the next one.
Symptoms
Many people have no symptoms for years, because the heart can compensate for a long time while the valve damage is mild. As the valves become more narrowed or leaky, and the heart strains to keep up, symptoms tend to emerge. These can include breathlessness, especially during exertion or when lying flat, tiredness, palpitations or an awareness of an irregular heartbeat, chest discomfort, and swelling of the ankles or legs. As the condition advances, features of heart failure or of an irregular rhythm such as atrial fibrillation can develop. A doctor listening to the chest may pick up a heart murmur – the sound of blood moving abnormally through a damaged valve – sometimes before the person notices anything at all.
Who is at risk
Rheumatic heart disease is now uncommon in places with good access to healthcare, where sore throats are readily assessed and treated, but it remains an important cause of heart disease worldwide. The main risk factor is a history of rheumatic fever, particularly more than one episode. Recurrent strep throat in childhood, and growing up in a region where rheumatic fever is still common, also raise the risk. In Singapore, the condition is most often seen in older adults and in people who spent their childhood in higher-risk parts of the world. Anyone with such a background who develops heart symptoms should mention it to their doctor, as it can point towards the diagnosis.
Complications
Damaged valves can lead to several complications over time. Heart failure may develop as the strained heart struggles to pump effectively. Atrial fibrillation, an irregular and often fast heart rhythm, is common when the upper chambers become stretched; it can cause palpitations and, importantly, raises the risk of a blood clot forming and travelling to the brain to cause a stroke. Damaged valves are also more vulnerable to infective endocarditis – a serious infection of the valve that can arise when bacteria enter the bloodstream. These complications are part of why regular follow-up and preventive care are so important once the condition is known.
How it is diagnosed
Diagnosis usually starts with the story and the examination. The doctor asks about any past strep throat, rheumatic fever, or a childhood in a higher-risk region, and listens to the heart, where a murmur may be heard. The key test is an echocardiogram – a heart ultrasound – which shows the valves in detail, revealing whether they are narrowed, leaky or both, and how well the heart is coping. An ECG (a recording of the heart’s electrical activity) can detect rhythm problems such as atrial fibrillation, and further tests, including a chest X-ray or blood tests, may be arranged to build a full picture. A cardiologist usually oversees this assessment.
Treatment
Treatment aims to manage symptoms and protect the heart. Medicines may be used to treat heart failure, to control the heart rhythm, and to thin the blood where there is a rhythm problem that raises stroke risk. People who have had rheumatic fever are often advised to take long-term preventive antibiotics to guard against further attacks that would cause more valve damage. In some situations, preventive antibiotics before certain procedures – such as some dental work – are recommended to reduce the chance of a valve infection. When a valve is severely damaged, repair or replacement surgery can restore proper blood flow and relieve strain on the heart. Your care team, usually led by a cardiologist and sometimes involving a heart surgeon, will tailor treatment to which valves are affected and how badly.
Prevention – the key message
The most powerful message is that rheumatic heart disease is largely preventable. Prompt treatment of strep throat with the right antibiotics stops rheumatic fever from developing in the first place, so a severe or persistent sore throat is worth having checked rather than ignored. For anyone who has already had rheumatic fever, taking the prescribed preventive antibiotics faithfully is the key to avoiding a recurrence and the further valve damage that comes with it. Preventing that next attack is far easier than repairing the heart afterwards.
Living with it and self-care
If you are living with rheumatic heart disease, a few habits protect your heart. Take your medicines exactly as prescribed, including any long-term preventive antibiotics, and do not stop them without speaking to your doctor. Look after your teeth and gums with good dental hygiene and regular dental care, because a healthy mouth lowers the chance of bacteria reaching the valves. Keep your follow-up appointments so the valves can be monitored over time. And tell your healthcare providers – including your dentist – about your valve condition, so they can take the right precautions, such as advising preventive antibiotics before certain procedures. HealthHub and your GP or cardiologist can point you to trustworthy information and support in Singapore.
When to see a doctor and red flags
See a doctor if you develop unexplained breathlessness, tiredness, palpitations, chest discomfort or swollen ankles, especially if you have a history of rheumatic fever or a childhood in a higher-risk region. Have a severe or persistent sore throat assessed so strep can be tested for and treated. Seek urgent care for worsening breathlessness, chest pain, fainting, or a persistent fever, which could signal an infection of a damaged valve. Call 995 for severe breathlessness or chest pain, or for stroke symptoms such as face drooping, arm weakness or slurred speech.
Related heart conditions & procedures
- Aortic stenosis (narrowed valve)
- Heart valve replacement & TAVI
- Aortic dissection
- Carotid artery disease
- Heart block & slow heart rate
- Infective endocarditis
- Pulmonary hypertension
- Heart bypass surgery (CABG)
- Cardiac catheterisation & angiogram
- Heart valve disease
- Coronary artery disease & angina
- Cardiologists in Singapore
Sources
- SingHealth / HealthHub (MOH), Singapore — valvular and rheumatic heart disease (rheumatic fever as an immune response to strep; symptom timing; preventability by treating strep throat; echocardiogram diagnosis).
- AHA / ACC guidance (via AAFP) — secondary prophylaxis with long-term penicillin; treatment of strep pharyngitis.
- Global Burden of Disease studies — global RHD burden (estimates), with mitral and aortic valves predominating.