What Are the Symptoms of Rheumatic Heart Disease?

Rheumatic heart disease (RHD) is a chronic, progressive condition resulting from permanent damage to heart valves following one or more episodes of acute rheumatic fever—an autoimmune inflammatory response triggered by untreated or inadequately treated group A Streptococcus infection. Symptoms often develop insidiously over years and may remain absent for decades after the initial rheumatic insult.

Early-stage RHD may be entirely asymptomatic, with valve abnormalities detected only incidentally on echocardiography. As valvular dysfunction worsens—most commonly affecting the mitral valve, followed by the aortic valve—patients may experience exertional dyspnea, fatigue, orthopnea, and paroxysmal nocturnal dyspnea due to left-sided heart failure. Palpitations and atrial fibrillation are frequent complications, particularly in those with mitral stenosis and left atrial enlargement.

Advanced disease can manifest with signs of right-sided heart failure—including peripheral edema, jugular venous distension, and hepatomegaly—as pulmonary hypertension develops secondary to chronic left-sided pressure overload. Hemoptysis may occur in severe mitral stenosis due to rupture of bronchial veins. In rare cases, embolic events such as stroke or systemic thromboembolism arise from left atrial thrombus formation.

Physical examination findings vary by affected valve(s) but may include characteristic murmurs: a low-pitched diastolic rumble at the apex in mitral stenosis; a high-pitched decrescendo diastolic murmur along the left sternal border in aortic regurgitation; or a holosystolic murmur radiating to the axilla in mitral regurgitation. Additional signs include malar flush (in mitral stenosis), capillary pulsations (Quincke’s sign), and a widened pulse pressure in significant aortic regurgitation.

Because symptom onset often reflects irreversible structural damage, early diagnosis via echocardiographic screening—especially in endemic regions or individuals with prior rheumatic fever—is critical for timely intervention, secondary prophylaxis, and prevention of further valvular deterioration.