Rheumatic heart disease occurs when the heart valves are persistently damaged as a result of respiratory infections. Heart valve damage can occur rapidly after an untreated or under-treated Streptococcal infection, such as strep throat or rheumatic fever. An immunological stimulatory effects an inflammatory response in the body, which can lead to long-term valve damage. Inflammation induced by rheumatic fever can cause damage to any area of the heart. The outside lining (pericardium), inner lining (endocardium), and valves are all included. Valvular heart disease, pericarditis, endocarditis, and heart block are all associated to disease.