What're the symptoms of rheumatic heart disease and rheumatic fever?

When rheumatic fever follows strep throat, symptoms usually appear within two to four weeks. The first sign may be a painful, inflamed knee or other large joint. As one joint improves, another is soon affected. There may be fever, aching, a rash, and small lumps under the skin. In addition to fever, another common symptom of the disease is arthritis of the ankles, knees elbows and wrists. The joints become red, hot, swollen, shiny and extraordinarily painful. The patient may experience a change in coordination, often first noted by changes in handwriting, and the arms or legs may flail or jerk uncontrollably. This symptom of rheumatic fever is called Sydenham's chorea or St. Vitus' Dance. A number of skin changes are common to rheumatic fever including a rash and small bumps occurring under the skin.

The most serious problem occurring in rheumatic fever is called pancarditis, an inflammation that affects all aspects of the heart, including the lining of the heart (endocardium), the sac containing the heart (pericardium), and the heart muscle itself (myocardium). About 40-80% of all rheumatic fever patients develop pancarditis. This complication has the most serious, long-term effects because the valves within the heart are frequently damaged.

The rheumatic fever that triggers this disease is often accompanied by painful joints and involuntary spasms. If inflammation of the heart also sets in, roughly half of its victims will remain unaware of it until years later, when results of the damage begin to surface. At the time of the fever, the most common cardiac symptom is a heart murmur detectable only through a stethoscope. Later, the condition will produce cardiac problems such as constant fatigue, lack of stamina, chest pain, irregular pulse, shortness of breath, and fainting spells.

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