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There were 3,257 people in the United States who died from rheumatic fever and rheumatic heart disease in 2006 according to the American Heart Association.
*Source: American Heart Association

Rheumatic Fever Overview

Rheumatic fever and rheumatic heart disease are complications of infection from group A streptococcus, a bacterium that causes strep throat and scarlet fever. It is the most common bacterial infection of the throat. Rheumatic fever becomes rheumatic heart disease when the inflammation it causes leads to permanent damage to heart valves and tissue. Among the serious cardiac complications of rheumatic fever:

  • Valve stenosis, a narrowing of the valve resulting in decreased blood flow
  • Valve regurgitation, a leak that allows blood to flow in the wrong direction
  • Weakened heart muscle and a decrease in proper pumping function
  • Atrial fibrillation, an irregular heartbeat (of the upper chambers)
  • Heart failure

Rheumatic fever most commonly strikes children between the ages of 5 and 15 years, but it may also occur in people of other ages. It most often recurs in adults between 25 and 35 years of age.

Rheumatic fever is relatively rare in the United States, although isolated outbreaks do occur, the most recent in the 1980s. The illness is common in developing countries, however.


People with rheumatic fever may show few or many symptoms, and their symptoms may change over time. These symptoms may begin to appear two to four weeks after the person contracts strep throat or scarlet fever, if those infections are not diagnosed and treated with a full course of antibiotics. Symptoms of rheumatic fever include:

  • Fever
  • Abdominal pain
  • Fatigue
  • Heart palpitations
  • Chest pain
  • Shortness of breath
  • Joints that are tender, painful, red or swollen (mainly the knees, ankles, elbows and wrists)
  • Painless rash with jagged edges (erythema marginatum); may look ring-shaped or snake-like
  • Small, painful nodules below the skin
  • Nosebleeds
  • Sydenham chorea or St. Vitus’ dance : jerky, uncontrollable body movements and muscle weakness, most often seen in the face, hands and feet
  • Unusual behavior, such as inappropriate crying or laughter (a symptom of Sydenham chorea)

Risk Factors

The best way to prevent rheumatic fever is to treat strep throat or scarlet fever with a full course of antibiotics. Risk factors for rheumatic fever include:

  • A family history of rheumatic fever
  • Exposure to particular strep strains – some strains contribute to rheumatic fever more than other strains
  • Unsanitary environmental conditions – overcrowding and other conditions that allow for easy and mass transmission of the strep bacteria