A child develops carditis from rheumatic fever. which areas of the heart are affected by carditis?

What is rheumatic fever?

Rheumatic fever is an inflammatory disease that can be triggered by a streptococcal bacterial infection. It usually starts out as a strep throat infection or scarlet fever that hasn’t been treated with antibiotics. Rheumatic fever can cause inflammation of connective tissues throughout the body including the heart, joints, brain or skin.

Rheumatic heart disease describes a group of short-term (acute) and long-term (chronic) heart disorders that are caused by rheumatic fever. It usually occurs 10-20 years after the initial illness. Not everyone with rheumatic fever will go on to develop rheumatic heart disease.

Types of rheumatic heart disease

Every part of the heart may be damaged by inflammation caused by rheumatic fever. That includes the outer sac (pericardium), the inner lining (endocardium) and the valves.

Some heart problems linked to rheumatic fever are:

• valvular heart disease
• pericarditis
• endocarditis
• heart block

The most common form of rheumatic heart disease affects the heart valves. It may take several years after an episode of rheumatic fever for valve damage to develop or symptoms to appear.

Although rheumatic fever can affect any heart valve, it most commonly affects the mitral valve which lies between the two chambers of the left side of the heart. The damage can cause valve stenosis, valve regurgitation and/or damage to the heart muscle.

• Valve stenosis occurs when there is narrowing of a valve, which restricts blood flow.
• Valve regurgitation is when blood leaks backward through a valve, instead of following its usual direction.
• The inflammation of rheumatic fever can damage the heart muscle itself. The damage can affect the heart’s ability to pump blood effectively.

In time, valve disorders may lead to atrial fibrillation or heart failure. 

Who is at risk?

Rheumatic fever is rare in developed countries, but one Canadian study showed that people living in certain Indigenous communities have a higher risk of contracting rheumatic fever. There is also a higher risk for people who have immigrated from countries where rheumatic fever is more common. People who have had repeated strep infections are also at a higher risk of developing rheumatic heart disease.

People of any age can experience a short bout of rheumatic fever, but it is most common between the ages of 5 and 15. Any child with a persistent sore throat should have a throat culture to check for strep infection.

About 60% of people with rheumatic fever go on to develop rheumatic heart disease. Antibiotics can prevent streptococcal infection from developing into rheumatic fever.

Symptoms

1. The symptoms of rheumatic fever include:

• fever
• painful joints
• migrating pain from joint to joint
• red, warm, swollen joints
• small, painless bumps beneath the skin
• chest pain
• heart murmur
• painless rash with a jagged edge (erythema marginatum)
• jerky movements
• unusual behaviours accompanying the movements

2. The symptoms of heart valve problems – which are often the result of rheumatic heart disease – can include:

• chest discomfort or pain
• irregular or rapid heartbeats (heart palpitations)
• shortness of breath
• fatigue or weakness
• light-headedness, dizziness or near fainting
• swelling of the stomach, feet, or ankles

If you have one or more of these symptoms, see your doctor. Get immediate medical help if you experience chest pain, fainting or difficulty breathing.

Diagnosis

Your doctor will diagnose rheumatic heart disease after reviewing your symptoms (or your child’s, if your child is ill), taking a medical history and giving you a complete physical exam.

There is no specific test for rheumatic heart disease. The first step will be to establish if you have had a strep infection. A throat culture and/or a blood test might be able to find strep antibodies if the infection was recent. If too much time has passed, the antibodies will be gone and the doctor will rely on your memory of recent illnesses.

Tests that will check your heart for damage include:

• echocardiogram
• chest X-ray

Treatment

Children or young adults with heart damage from rheumatic fever may need to take daily antibiotics until they are 25 to 30 years old. This helps to prevent another bout of rheumatic fever and avoid the development of infective endocarditis – an infection of the heart valves or lining of the heart.

Additional treatment will depend on the type of damage to your heart. You and your doctor will discuss treatment options and decide which is best for you and your circumstances.

You can lower your risk of developing other heart diseases and stroke by knowing and controlling your blood pressure, diabetes and blood cholesterol. It is also important to lead a healthy lifestyle.

• Be smoke-free.
• Be more active.
• Eat a healthy balanced diet – there are some specific diets you can follow that have been proven to reduce the risk of heart disease.
• Aim for a healthy weight.
• Drink less alcohol.
• Manage stress.

Talk to your doctor about the lifestyle changes that will benefit you the most.

Living with rheumatic heart disease

It’s normal to feel worried or afraid after a diagnosis of rheumatic heart disease. Find someone you can turn to for emotional support like a family member, friend, doctor, mental health worker or support group. Talking about your challenges and feelings could be an important part of your journey to recovery.

• The recovery and support section is full of practical advice and tips to support you on your recovery journey.
• Find peer support resources here.
• Download or order our free book Living Well with Heart Disease.
• Join Heart & Stroke’s Community of Survivors or Care Supporters’ Community support groups.
• Sign up for the Heart & Stroke recovery newsletter. Get the latest research news and information, with tips and strategies to help you manage your recovery. 

Looking for support?

Check out our support & recovery section