Acute rheumatic heart disease (ARHD) is a serious inflammatory condition that can occur as a complication of rheumatic fever, which is triggered by an untreated streptococcal throat infection. It primarily affects the heart valves, leading to inflammation, scarring, and, potentially, permanent damage that can result in heart failure. The condition is more common in children and young adults, particularly in developing countries, and its occurrence has significantly declined in developed nations due to improved healthcare and access to antibiotics.

Several factors increase the risk of developing acute rheumatic heart disease, including a history of rheumatic fever, recurrent streptococcal infections, and limited access to healthcare. Social determinants such as poverty, overcrowding, and lack of education contribute to the prevalence of rheumatic fever and, consequently, ARHD. Genetic predisposition may also play a role, as some individuals may be more susceptible to autoimmune responses following streptococcal infections.

The symptoms of acute rheumatic heart disease may vary widely, but they often include fever, joint pain, and fatigue, along with more specific signs related to heart function, such as palpitations or chest pain. Patients may also present with shortness of breath due to heart valve dysfunction or congestive heart failure. In severe cases, symptoms can escalate rapidly, necessitating immediate medical attention.

Acute rheumatic heart disease primarily results from an autoimmune response to an infection caused by group A streptococcus, typically following an episode of untreated or inadequately treated streptococcal pharyngitis (strep throat). The body's immune system mistakenly attacks its own tissues, particularly in the heart, joints, skin, and brain. Factors such as genetic predisposition and socioeconomic conditions can increase the risk of developing this condition, especially in children and young adults in developing countries.

Diagnosis of acute rheumatic heart disease typically involves a combination of patient history, physical examination, and diagnostic testing. Clinicians may conduct a thorough cardiovascular examination to identify heart murmurs indicating valve damage, and laboratory tests, including throat cultures, ASO titers, and echocardiograms, can provide critical information on the presence of streptococcal infection and the extent of heart involvement. Clinical criteria established by the Jones criteria are often utilized to confirm the diagnosis.

Management of acute rheumatic heart disease involves a multi-faceted approach, including the use of anti-inflammatory agents such as aspirin or corticosteroids to control inflammation and alleviate symptoms. Additionally, antibiotic prophylaxis is crucial to prevent recurrent streptococcal infections, which can exacerbate heart damage. In severe cases, surgical intervention may be necessary to repair or replace damaged heart valves, and ongoing monitoring by a cardiologist is essential for long-term management.

Preventing acute rheumatic heart disease primarily involves the timely treatment of streptococcal infections with appropriate antibiotics, such as penicillin. Public health initiatives aimed at decreasing the incidence of rheumatic fever, including promoting awareness about the importance of treating sore throats, improving sanitation, and increasing access to healthcare, are vital. Long-term prophylaxis with antibiotics is recommended for individuals with a history of rheumatic fever to prevent recurrence and potential progression to ARHD.