As rheumatic fever is the underlying cause of rheumatic heart disease, the most effective treatment approach is to prevent rheumatic fever. This is achieved by timely and appropriate antibiotic treatment of streptococcal infections.

When rheumatic fever develops, antibiotics are used to eradicate the infection and halt its progression. Anti-inflammatory medications may also be prescribed to reduce inflammation and minimize the risk of cardiac damage. In cases where heart failure develops, additional medications may be added to the treatment regimen.

Individuals who have experienced rheumatic fever may receive prophylactic antibiotic treatment, either lifelong or for a specific period (e.g., until age 40), depending on the degree of heart valve damage, to prevent recurrent infections and subsequent risk of further cardiac damage. Aspirin, steroids, or non-steroidal anti-inflammatory drugs (NSAIDs) may be used to control acute inflammation.

In situations where heart damage has occurred, treatment is determined by the extent of damage rheumatic fever has caused to the heart valves. In severe cases, surgical interventions, such as the repair or replacement of severely damaged heart valves, may be necessary.