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Rheumatic Heart Disease G008

Last amended 
9 May 2019
Current RMA Instruments
Reasonable Hypothesis SOP
51 of 2019
Balance of Probabilities SOP
52 of 2019
Changes from previous Instruments

SOP Bulletin 208

ICD Coding
  • ICD-9-CM Codes: 393 - 398
  • ICD-10-AM Codes: I05, I06, I07, I08, I09
Brief description

Rheumatic heart disease is chronic damage to the heart, particularly the heart valves, due to acute rheumatic fever in the past.

Confirming the diagnosis

The diagnosis may be suspected in someone with a history of acute rheumatic fever and with a heart murmur.  Confirmation of diagnosis generally requires echocardiography, showing characteristic morphologic features.

The relevant medical specialist is a cardiologist.

Additional diagnoses covered by SOP
  • Rheumatic aortic valve incompetence or stenosis
  • Rheumatic mitral valve incompetence or stenosis
  • Rheumatic pulmonary valve disease
  • Rheumatic tricuspid valve incompetence or stenosis
  • Chronic rheumatic myocarditis
  • Chronic rheumatic pericarditis
Conditions not covered by SOP
  • Acute rheumatic fever*
  • Acute rheumatic carditis* - Acute rheumatic fever SOP
  • Recurrent acute rheumatic fever*
  • Any heart valve disease not due to past rheumatic fever, e.g.:
    • non-rheumatic aortic stenosis* - aortic stenosis SOP
    • non-rheumatic mitral incompetence - may be covered by mitral valve prolapse SOP

*another SOP applies

Clinical onset

The latency from initial infection (acute rheumatic fever) to first manifestation of chronic heart disease can range from months to decades. In a significant proportion of cases there will be no known history of prior rheumatic fever, due to the condition being sub-clinical, or not detected.  Onset of rheumatic heart disease is most often between ages 20 to 50 but can be earlier or later.  Clinical manifestations vary with the valves or other structures involved and with the severity of involvement, but dyspnoea (shortness of breath), exertional dizziness, or arrhythmia (atrial fibrillation) may be present and a heart murmur may be heard.

Clinical worsening

The course of the condition is variable.  More severe cases can progress to heart failure or the need for surgical intervention for damaged valves.  Appropriate treatment, including prevention of new heart infection, can limit progression.