Rheumatic heart disease is caused by rheumatic fever, which is an inflammatory disease that can damage heart valves following a streptococcal infection like strep throat. India has a high burden of RHD, accounting for over a third of global deaths from the disease. Risk factors include low socioeconomic status, poor housing conditions, and inadequate access to healthcare. Diagnosis involves collecting a medical history, physical exam, ECG, echocardiogram, and lab tests. Prevention focuses on identifying and treating streptococcal infections early, particularly in high-risk school-aged children through continued antibiotic injections over many years. Improving living standards can also help break cycles of poverty and disease.