[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Heart](https://durgical.com/en/general-pathology/areas/heart/) › Rheumatic fever and rheumatic heart disease # Rheumatic fever and rheumatic heart disease - Lesion After a strep throat, the immune system can attack the heart. Repeated attacks scar the valves, especially the mitral valve. Updated Nov 12, 2026 ## Key points - Onset about 2 to 4 weeks after group A streptococcal pharyngitis (not skin infection); children 5 to 15. - Jones major criteria: carditis, migratory polyarthritis of large joints, Sydenham chorea, erythema marginatum, subcutaneous nodules; plus evidence of recent strep infection. - Aschoff bodies: foci of T cells, plasma cells and activated macrophages (Anitschkow ‘caterpillar’ cells) around fibrinoid necrosis. - Acute valvulitis: small warty vegetations along lines of closure; MacCallum plaques in the left atrium. - Chronic disease: mitral stenosis with fused commissures and thick, short, fused chordae (‘fish-mouth’ or ‘buttonhole’ valve); mitral is affected almost always, aortic often. - Chronic mitral stenosis leads to left atrial dilation, atrial fibrillation, mural thrombi, pulmonary hypertension and right heart failure. ## What it is Acute rheumatic fever is an immune-mediated multisystem disease that follows group A streptococcal pharyngitis by a few weeks in susceptible children. Antibodies and T cells against streptococcal M protein cross-react with heart, joint, skin and brain proteins (molecular mimicry). Acute carditis involves all three layers (pancarditis). Recurrent episodes cause chronic rheumatic heart disease, a fibrotic deformity of valves, mainly the mitral, that remains the commonest acquired heart disease of children and young adults in low- and middle-income countries, including parts of Latin America. ## Structure - Acute: fibrinous pericarditis; Aschoff bodies in the myocardium; small verrucae along valve closure lines. - Chronic mitral valve: thick, fibrotic leaflets, commissural fusion, shortened thickened fused chordae, calcification; neovascularisation of the leaflets. ## Step by step - Group A streptococci infect the pharynx of a genetically susceptible child. - The immune response targets M protein and other bacterial antigens. - Antibodies and CD4 T cells cross-react with cardiac myosin, valve proteins and other tissues. - Acute inflammation affects pericardium, myocardium (Aschoff bodies) and valves (verrucous vegetations). - Repeated infections cause repeated attacks; valves heal by fibrosis, fusion and calcification. - Years later the scarred valves narrow or leak: chronic rheumatic heart disease. ## Clinical notes - Secondary prophylaxis with penicillin prevents recurrences and progression. - Rheumatic heart disease is still common in parts of Latin America and the Caribbean and among underserved communities. ## Memory aid A throat infection weeks ago, a heart that confuses itself with the germ: Aschoff in the muscle, fish-mouth in the mitral. ## Test yourself Think of the answer, then tap the question to see it. ## What are Aschoff bodies? Inflammatory foci in acute rheumatic carditis: T cells, plasma cells and plump macrophages (Anitschkow cells) around fibrinoid necrosis. ## Which valve is almost always involved in chronic rheumatic heart disease? The mitral valve, typically with stenosis and a fish-mouth deformity. ## What is the mechanism of rheumatic fever? Molecular mimicry: antibodies and T cells against streptococcal M protein cross-react with heart and other host proteins. ## Which infection precedes rheumatic fever? Group A streptococcal pharyngitis, a few weeks earlier. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/general-pathology/rheumatic-fever-and-rheumatic-heart-disease/) [More Pathology questions →](https://durgical.com/en/practice/?f=pathology) ## Elsewhere in DurgiPedia - [Molecular mimicry and post-infectious autoimmunity](https://durgical.com/en/immunology/molecular-mimicry-and-post-infectious-autoimmunity/) - [Type II hypersensitivity (antibody against cells)](https://durgical.com/en/immunology/type-ii-hypersensitivity/) ## Connections ## Related 5 - [Valve disease: causes by valve](https://durgical.com/en/general-pathology/valve-disease-causes-by-valve/) - [Non-infected vegetations: marantic, Libman–Sacks, carcinoid](https://durgical.com/en/general-pathology/non-infected-vegetations-marantic-libman-sacks-carcinoid/) - [Infective endocarditis](https://durgical.com/en/general-pathology/infective-endocarditis/) - [Granulomatous inflammation: caseating vs non-caseating, the causes to know](https://durgical.com/en/general-pathology/granulomatous-inflammation-caseating-vs-non-caseating-the-causes-to-know/) - [Pericardial disease](https://durgical.com/en/general-pathology/pericardial-disease/) ## Related conditions 6 - [Rheumatic heart disease](https://durgical.com/en/conditions/rheumatic-heart-disease/) - [Mitral stenosis](https://durgical.com/en/conditions/mitral-stenosis/) - [Streptococcal pharyngitis](https://durgical.com/en/conditions/streptococcal-pharyngitis/) - [Mitral regurgitation](https://durgical.com/en/conditions/mitral-regurgitation/) - [Aortic regurgitation](https://durgical.com/en/conditions/aortic-regurgitation/) - [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/) ## Microorganisms 1 - [Streptococcus pyogenes](https://durgical.com/en/microbiology/streptococcus-pyogenes/) [← All of general pathology](https://durgical.com/en/general-pathology/) Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given. Sources: [Rheumatic fever: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003940.htm) (MedlinePlus, US National Library of Medicine, 2025); [Current Situation of Acute Rheumatic Fever and Rheumatic Heart Disease in Latin America and the Caribbean: A Systematic Review](https://europepmc.org/article/PMC/PMC9438465/) (Global heart, 2022). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/rheumatic-fever-and-rheumatic-heart-disease/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/rheumatic-fever-and-rheumatic-heart-disease/