When you think of a sore throat, you likely imagine temporary discomfort caused by a mild viral infection. However, there are instances when it can be the beginning of long-term heart complications such as heart failure. Read on to learn more about how a sore throat can be linked to rheumatic heart disease.

What is Rheumatic Heart Disease (RHD)?

Rheumatic heart disease (RHD) is a chronic and potentially life-threatening condition in which the heart’s valves are permanently damaged if you are diagnosed with rheumatic fever. This is commonly an inflammatory illness that can develop after an untreated or incorrectly treated Group A Streptococcus (strep) throat infection. While fighting the initial throat infection, your immune system can mistakenly attack your heart tissue, affecting valves that control the blood flow between the heart’s chambers.
Over time, this is what can happen:

• The valves can thicken, scar and lose their ability to open/close properly.
• Valve narrowing (stenosis) or leakage (regurgitation).
• Disrupted blood flow, placing pressure on the valves.
• Complications such as heart failure, arrhythmias, stroke, or even death.

How Does a Sore Throat Progress to Heart Failure?

The Initial Infection

In most cases, it starts with an infection caused by the Group A Streptococcus bacterium, which is responsible for strep throat, a condition that causes symptoms such as a sore throat, fever, swollen tonsils, and painful swallowing. In children and teens, strep throat is particularly common and resolves quickly. Still, adults can also be affected and are at a higher risk of experiencing severe complications without proper antibiotics. However, treatment is necessary to reduce the risks of the immune system damaging the tissues surrounding your heart.

The Autoimmune Reaction

If strep throat isn’t adequately treated, it can lead to rheumatic fever, which is an inflammatory disease. In this phase, the antibodies start to attack the body’s tissue, including the heart, joints, skin, and nervous system. Symptoms can start showing 2 to 4 weeks after the throat infection, and you might notice swelling that can take weeks to several months to go away.

Irreversible Rheumatic Heart Disease

Over time, inflammation and scarring from rheumatic fever can deform the aortic and mitral heart valves. This is the stage where you can get diagnosed with rheumatic heart disease. Even though it might take years to develop, it can still lead to serious complications such as abnormal blood flow, arrhythmias, and heart failure.

Why This Still Matters Today

While rheumatic fever has become increasingly rare in first-world countries, it remains a significant public health problem in many low- and middle-income regions because of poor access to high-quality healthcare services and resources. According to the World Health Organization, rheumatic heart disease affects over 55 million people worldwide and causes hundreds of thousands of deaths each year.

Early Symptoms to Watch For

Strep Throat Symptoms:

• Sudden severe sore throat.
• Painful swallowing.
• Fever.
• Swollen, red tonsils, sometimes with white patches.
• Swollen lymph nodes in the neck.

Rheumatic Fever Symptoms:

• Fever.
• Painful, swollen joints often moving from one joint to another.
• Skin rash.
• Uncontrolled movements in the hands, face and feet known as Sydenham chorea.
• Chest pain or shortness of breath due to heart inflammation.

Diagnosis and Treatment

1. Strep Throat

The type of infection you have is commonly diagnosed with a rapid strep test or a throat culture. Once confirmed, treatment involves a full course of antibiotics (usually penicillin or amoxicillin), even if symptoms improve quickly. Completing the whole course is vital to prevent complications.

2. Rheumatic Fever

If there are signs of rheumatic fever following a strep throat diagnosis, your doctor may prescribe anti-inflammatory medications such as aspirin or corticosteroids to reduce inflammation in infected areas. If the bacteria are still present, antibiotics can help eradicate the remaining Group A Streptococcus, or you could be placed on long-term antibiotic prophylaxis, often involving monthly injections of penicillin to prevent inflammation recurrence.

3. Rheumatic Heart Disease

If you are diagnosed with rheumatic heart disease, you require specialised chronic disease management, which could involve a combination of:

• Regular monitoring by a cardiologist.
• Medications to manage heart failure or arrhythmias.
• Surgical valve repair or replacement in severe cases.

How to Prevent Rheumatic Heart Disease

The good news is that rheumatic fever and rheumatic heart disease are entirely preventable if strep throat is diagnosed and treated early. Prevention often includes:

• Prompt medical attention for sore throats, especially in children and teens.
• Adherence to prescribed antibiotics by not stopping treatment before the course runs out.
• Regular follow-up is recommended if you have a history of rheumatic fever.

While a sore throat may seem like something minor that can be treated with over-the-counter medication, you won’t know whether Group A Streptococcus causes it if you don’t seek immediate medical advice. Most importantly, when left untreated, it can trigger life-threatening immune reactions that lead to rheumatic fever and ultimately heart failure. When you have an Affinity Health Day-to-Day or Combined plan, you can stay healthy with unlimited Telehealth consults, GP visits and acute medication to prescribe proper treatment when you have a sore throat.