Rheumatic Heart Disease

Rheumatic heart disease (RHD) is a notifiable chronic condition caused by damage to the heart valves, which occurs after single or repeated episodes of acute rheumatic fever (ARF). ARF is an autoimmune disease which occurs following infection with Group A Streptococcus bacterium (Strep). Repeated episodes of ARF can lead to accumulative damage to the heart valves, which may require surgery.

If untreated, RHD can lead to heart failure and complications like stroke and can greatly reduce the ability to lead a normal life.

RHD can cause complications in pregnancy.

Risk groups for RHD

At high risk

  • Living in an ARF-endemic setting (e.g. ARF incidence >30/100,000 per year in 5 to14-year-olds, or RHD prevalence >2/1000).
  • Aboriginal and/or Torres Strait Islander peoples living in rural or remote settings;  
  • Aboriginal and/or Torres Strait Islander peoples, and Maori and/or Pacific Islander peoples living in metropolitan households affected by crowding and/or lower socioeconomic status.
  • Personal history of ARF/RHD and aged >40 years.
  • Family or household recent history of ARF/RHD.

May be at high risk/additional considerations

  • Family or household recent history of ARF/RHD.
  • Household overcrowding (2 or more people per bedroom) or low socioeconomic status
  • Migrant or refugee from low-or middle-income country and their children.
  • Prior residence in or frequent recent travel to a high ARF risk setting.
  • Aged 5 to 20 years (peak years for ARF).

Strep infections, ARF and RHD are preventable with improved housing and living conditions and early antibiotic treatment.

Signs and Symptoms: 

Signs and symptoms of RHD may not be noticed for many years. When they do develop they are dependent on how severe the damage to the heart valves is and can include:

  • shortness of breath

  •  chest pain

  •  swelling of the legs and face

  • weakness or tiredness

  •  fainting

  • heart palpitations

  • heart murmur.

The goal of treatment for RHD is to prevent further episodes of ARF which worsen the heart valve damage. The only effective control strategy for RHD is a penicillin injection called benzathine benzylpenicillin G (BPG or Bicillin) every 3 to 4 weeks. 

Having regular antibiotic preventive treatment is crucial to the effectiveness of preventing further damage to the heart.


3 to 4 weekly injections of Bicillin continued for many years are the most important measure to prevent further episodes. 
The Rheumatic Heart Disease Register and Control Program has been established in Queensland to; support healthcare providers, coordinate the long-term management of patients with acute rheumatic fever (ARF) and rheumatic heart disease (RHD).

Some of the methods to reduce the incidence and impact of rheumatic heart disease include:

  • Prevention and early treatment of Strep infections of the throat and skin with antibiotics.
  • Regular penicillin injections (Bicillin) every 3 to 4 weeks to prevent further episodes of ARF.
  • Reducing symptoms and minimising disability associated with RHD through medications and sometimes surgery.

Health outcome: 

Without strict adherence to antibiotic prophylaxis, a person who has had an episode of ARF is likely to get another one. Repeated episodes of ARF inevitably lead to the development or worsening of RHD. This can lead to heart failure as well as increased risk of complications such as an abnormal heart rhythm, stroke and infection and inflammation of the heart tissue. Severe RHD usually requires open heart surgery to repair or replace the valves.

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