Rheumatic heart disease (RHD) is the most common acquired heart disease in children in many countries of the world. Rheumatic heart disease is permanent damage to the heart following rheumatic fever. It can lead to heart failure and sometimes the need for cardiac surgery. One common result of rheumatic fever is heart valve damage. This damage to the heart valves may lead to a valve disorder. Symptoms of heart valve problems, which are often the result of rheumatic heart disease, can include: chest pain, excessive fatigue, heart palpitations (when the heart flutters or misses beats), a thumping sensation in the chest, shortness of breath, and swollen ankles, wrists or stomach. If heart damage from rheumatic fever is identified in childhood or young adulthood, daily antibiotics may be required until the age of 25 or 30, to help prevent recurrence of rheumatic fever