Definition

Rheumatic fever causes inflammation or a swelling and irritation of tissue. The heart valves, skin, joints, and nerves can all be affected. Rheumatic fever can also cause permanent damage to heart valves and heart disease.

Diseased Heart Valve
Diseased Aortic Valve

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Causes

Rheumatic fever is caused by your body's response to a type of bacteria. The bacteria causes strep throat. Your body makes antibodies to fight the infection. These antibodies also begin to attack healthy tissue in the body. It is not clear why this happens.

Risk Factors

Rheumatic fever is more common in children aged 5 to 15 years. Other factors that may increase your chances of rheumatic fever include:

  • Having strep throat
  • History of rheumatic fever

Symptoms

Symptoms usually appear 2 to 4 weeks after a strep infection. They may include:

  • Pain and swelling in large joints
  • Fever
  • Weakness
  • Muscle aches
  • Shortness of breath
  • Chest pain
  • Nausea and vomiting
  • Hacking cough
  • Circular rash
  • Lumps under the skin
  • Abnormal, sudden movements of arms and legs

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. This will include a careful exam of your heart. Tests will be done to look for signs of infection. Tests may include:

  • Blood tests
  • Throat culture—to test for type of bacteria

Images and tests of the heart may be done to look for any damage. Tests may include:

Treatment

The goal of treatment is to kill the strep bacteria and stop the inflammation. Other steps may be needed to help prevent future infections.

Other treatment may be needed to treat any heart problems.

Medication

Antibiotics are used to treat the strep infection. They may be given by mouth or injection. Antibiotics will also need to be taken for several years after rheumatic fever. It will help to prevent another strep infection. Repeated infections can cause more damage to the heart.

Joint pain and swelling may be managed with:

  • Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroids—if NSAIDs are not effective or if there is inflammation of the heart

Note : Aspirin can cause serious complications in some children with certain infections. It is best to avoid aspirin or aspirin products for children with infections.

Rest

Inflammation can be severe. It can cause joint soreness and stiffness. Rest may be needed for a period of time.

Prevention

Contact the doctor if you or your child has a sore throat and a fever that lasts more than 24 hours. This is often the first sign of strep throat.

It is important to take all antibiotics if you have strep throat. Finish antibiotics even if you feel better. This will help to prevent rheumatic fever.

RESOURCES:

American Heart Association
http://www.heart.org

National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

REFERENCES:

Acute rheumatic fever. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116561/Acute-rheumatic-fever. Updated May 4, 2018. Accessed September 9, 2019.

Chakravarty SD, Zabriskie JB, Gibofsky A. Acute rheumatic fever and streptococci: the quintessential pathogenic trigger of autoimmunity. Clin Rheumatol. 2014 Jul;33(7):893-901

Rheumatic fever. Texas Heart Institute website. Available at: https://www.texasheart.org/heart-health/heart-information-center/topics/rheumatic-fever/. Accessed September 9, 2019.

Last reviewed September 2019 by David L. Horn, MD, FACP  Last Updated: 9/4/2019