Rheumatic Heart Disease
Rheumatic heart disease damages heart valves, often decades after a childhood strep throat was never fully treated. The one genuinely preventable step is treating that throat infection properly, the first time.
Medically reviewed by the RIIMS medical team · Last updated: June 2026
Go to hospital now
- Severe breathlessness at rest
- Chest pain
- Fainting or a sudden loss of consciousness
- A high fever with a new or worsening heart murmur can mean an infection settling on a damaged valve (infective endocarditis) and needs urgent hospital assessment
See a doctor soon (not an emergency)
- A new heart murmur found on any examination
- A childhood history of rheumatic fever without ongoing antibiotic follow-up
- Breathlessness or tiredness that is new or worsening in someone with known valve disease
What is rheumatic heart disease, and can it be prevented?
Rheumatic heart disease is damage to one or more heart valves that follows rheumatic fever, an inflammatory reaction the body can have after a throat infection with group A streptococcus bacteria, commonly called strep throat, that was not treated or not treated fully. The valve damage often shows up 20 to 30 years after the original throat infection, so the connection is easy to miss entirely. The World Health Organization estimates rheumatic heart disease affects 55 million people worldwide and causes around 360,000 deaths a year, most in low- and middle-income countries. In India, one widely used estimate, based on the 2011 census, puts the number of people affected at around 3.6 million, with about 44,000 new cases added every year, though the true figure may be higher since data from some large, underserved states is limited. The encouraging trend is that prevalence has fallen substantially, from an estimated 1 to 11 per 1,000 people in surveys from the 1970s to 1990s, to under 1 per 1,000 in studies after 2000. One number needs care in how it is read: a school screening study in Andhra Pradesh found rheumatic heart disease in 7.6 per 1,000 children using echocardiography, compared with only 0.7 per 1,000 using a stethoscope alone. That tenfold gap does not mean the disease became more common between the two studies; it means echocardiography finds early valve changes a stethoscope cannot hear, so the two numbers measure different things and should not be compared directly as if the disease rate itself changed. Here is the one genuinely preventable step, stated by the WHO itself: treating strep throat promptly with the appropriate antibiotic prevents rheumatic fever from developing in the first place. This is prevention of the fever that causes valve damage, not a treatment for valve damage that has already happened. Once a valve is damaged, ongoing antibiotic prophylaxis, injections of benzathine penicillin every few weeks, protects against further damage from repeat infections, though it does not undo scarring that has already occurred. In several Indian states, consistent access to benzathine penicillin for this long-term prevention is a genuine practical problem, not a matter of a patient's discipline alone.
Symptoms to watch for
- Often no symptoms for years after the original throat infection
- Breathlessness on exertion, as valve damage progresses
- Tiredness and reduced ability to exercise
- Swelling in the feet or legs
- A fluttering or irregular heartbeat
- A heart murmur found incidentally on examination
When to consult a doctor
Get any sore throat with fever in a child properly assessed and treated, since this is the step that actually prevents rheumatic fever. If rheumatic heart disease has already been diagnosed, keep to the antibiotic prophylaxis schedule your doctor has set, and ask about it directly if access has been difficult.