Rheumatic heart disease


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Rheumatic heart disease

Cardiovascular system

Vascular disorders

Arterial disease

Angina pectoris

Stable angina

Unstable angina

Myocardial infarction

Prinzmetal angina

Coronary steal syndrome

Peripheral artery disease

Subclavian steal syndrome


Aortic dissection


Behcet's disease

Kawasaki disease


Hypertensive emergency

Renal artery stenosis

Coarctation of the aorta

Cushing syndrome

Conn syndrome


Polycystic kidney disease


Orthostatic hypotension


Familial hypercholesterolemia



Chronic venous insufficiency


Deep vein thrombosis




Vascular tumors

Human herpesvirus 8 (Kaposi sarcoma)


Congenital heart defects

Truncus arteriosus

Transposition of the great vessels

Total anomalous pulmonary venous return

Tetralogy of Fallot

Hypoplastic left heart syndrome

Patent ductus arteriosus

Ventricular septal defect

Coarctation of the aorta

Atrial septal defect

Cardiac arrhythmias

Atrial flutter

Atrial fibrillation

Premature atrial contraction

Atrioventricular nodal reentrant tachycardia (AVNRT)

Wolff-Parkinson-White syndrome

Ventricular tachycardia

Brugada syndrome

Premature ventricular contraction

Long QT syndrome and Torsade de pointes

Ventricular fibrillation

Atrioventricular block

Bundle branch block

Pulseless electrical activity

Valvular disorders

Tricuspid valve disease

Pulmonary valve disease

Mitral valve disease

Aortic valve disease


Dilated cardiomyopathy

Restrictive cardiomyopathy

Hypertrophic cardiomyopathy

Heart failure

Heart failure

Cor pulmonale

Cardiac infections



Rheumatic heart disease

Pericardial disorders

Pericarditis and pericardial effusion

Cardiac tamponade

Dressler syndrome

Cardiac tumors

Cardiac tumors

Cardiovascular system pathology review

Acyanotic congenital heart defects: Pathology review

Cyanotic congenital heart defects: Pathology review

Atherosclerosis and arteriosclerosis: Pathology review

Coronary artery disease: Pathology review

Peripheral artery disease: Pathology review

Valvular heart disease: Pathology review

Cardiomyopathies: Pathology review

Heart failure: Pathology review

Supraventricular arrhythmias: Pathology review

Ventricular arrhythmias: Pathology review

Heart blocks: Pathology review

Aortic dissections and aneurysms: Pathology review

Pericardial disease: Pathology review

Endocarditis: Pathology review

Hypertension: Pathology review

Shock: Pathology review

Vasculitis: Pathology review

Cardiac and vascular tumors: Pathology review

Dyslipidemias: Pathology review


Rheumatic heart disease


0 / 25 complete

USMLE® Step 1 questions

0 / 4 complete

High Yield Notes

10 pages


Rheumatic heart disease

of complete


USMLE® Step 1 style questions USMLE

of complete

A 70-year-old man comes to the emergency department for evaluation of dyspnea, dizziness, and associated chest pain. He became more concerned when he was walking up stairs and suddenly “passed out.” His medical history includes type 2 diabetes mellitus, for which he takes metformin. He smoked one pack per day for forty years but does not use excessive alcohol or illicit drugs. His temperature is 37.0°C (98.6°F), pulse is 80/min, and blood pressure is 139/75 mmHg. On physical examination, a systolic murmur is appreciated over the right sternal border, which decreases with sustained hand grip. Which of the following is the most likely underlying cause of this patient's condition? 

External References

First Aid









rheumatic fever p. 321

Hypersensitivity reactions p. 110-111

rheumatic fever p. 320

M protein

rheumatic fever and p. 134


for rheumatic fever p. 321


prophylaxis (rheumatic fever) p. 195

Rheumatic fever p. 321

chorea with p. 537

heart murmur with p. 298

Streptococcus pyogenes p. , 134

streptolysin O p. 131

type II hypersensitivity p. 110

Type II hypersensitivity reactions

rheumatic fever p. 320


Content Reviewers

Rishi Desai, MD, MPH

Tanner Marshall, MS


Tanner Marshall, MS

Jake Ryan

Robyn Hughes, MScBMC

“Rheumatism” is used to describe inflammation in the joints, muscles, and the fibrous tissue, so rheumatic fever is a type of inflammatory disease that can damage the heart tissue, and lead to rheumatic heart disease.

Rheumatic fever develops after streptococcal pharyngitis, inflammation of the throat due to Streptococcus pyogenes where pyogenes literally means “makes pus”. The bacteria is sometimes referred to as “Group A beta hemolytic” streptococcus, and the infection itself is most often just called Strep throat. This particular group of streptococcus has an antigen that lumps it into a group called “group A”, and it also produces an enzyme called streptolysin, that completely lyses nearby red blood cells, or causes them to rupture—rupturing red blood cells is called hemolysis, right? And when those red blood cells rupture and are destroyed, it’s called beta-hemolysis—as opposed to alpha-hemolysis, where cells aren’t actually destroyed, they’re just damaged or bruised.

Some of these strep bacteria have a protein on their cell wall called “M protein”, and this particular protein is highly antigenic, meaning that the immune system sees it and recognizes it as a foreign molecule, and mounts an immune response, which rightfully so, produces antibodies against these proteins. Those antibodies, though, are thought to cross-react with proteins on some of our body’s own cells, like cells in the myocardium (or heart muscle) and heart valves, but also cells in the joints, the skin and the brain.

This phenomenon, where antibodies accidentally target proteins on our own cells because they look like the proteins on foreign cells, is called molecular mimicry, and is an example of what’s called a type 2 hypersensitivity reaction. Once bound to cardiac tissue, the antibodies activate nearby immune cells, which causes a cytokine-mediated inflammatory response and tissue destruction.


Rheumatic heart disease is a condition that develops as a complication of rheumatic fever, which is an inflammatory disease that can occur as a complication of streptococcal infections such as strep throat. This occurs due to the antibodies against streptococcal M proteins that cross-react with proteins in the myocardium, heart valves, joints, skin, and brain.

Rheumatic heart disease is characterized by heart tissue scarring that damages the heart valves, leading to problems such as mitral stenosis, and aortic regurgitation. Symptoms of rheumatic heart disease include shortness of breath, fatigue, chest pain, and heart palpitations. Treatment may involve antibiotics to prevent further streptococcal infections, and surgery to repair or replace damaged heart valves.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Acute rheumatic fever" The Lancet (2005)
  5. "Rheumatic fever & rheumatic heart disease: the last 50 years" Indian J Med Res (2013)
  6. "Rheumatic heart disease" The Lancet (2012)
  7. "Rheumatic Heart Disease: Causes, Symptoms, and Treatments" Cell Biochemistry and Biophysics (2015)

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