Background: exposure of the body's connective tissue to group A β-hemolytic streptococci, after an infection, causes an inflammatory response called Rheumatic fever (RF). When the heart's connective tissue is affected, the condition is called Rheumatic heart disease (RDH). Aim of the Work: we aimed at discovering the prevalence of RDH among cardiac patients and to determine factors that played a role in its development. Also, the study was conducted to find out the causal relationship between early treatment of RF and the occurrence of RHD. Patients and Methods: faisal Hospital's cardiac outpatient clinics, in Taif, KSA, who filled a designed questionnaire after training. To screen the population for the prevalence of RDH among cardiac patients and to determine factors that played a role in its development. Also, it was conducted to find the causal relationship between early treatment of RF and the occurrence of RHD. The ages were from 18 to 70 years old. Results: the overall prevalence of RHD among cardiac patients was 8%. The difference in prevalence of RHD was statistically significant (p=0.021) between patients whose family sizes exceeded 10 individuals (37.5%) compared to those whose family sizes was 10 individuals or less (62.5%). Also, the difference in prevalence of RHD was statistically significant (p=0.044) between patients who had little (37.5%) or no knowledge (37.5%) about symptoms of RHD compared to those who had moderate (25%) or good knowledge (0%) about symptoms of RHD.  The effect of RF management on RHD was studies and it was found that irregular and incomplete antibiotic therapy in case of tonsillitis (p=0.006) and irregular oral hygiene (p=0.027) were associated with higher prevalence rates of the disease. Conclusion: The that efficient management of rheumatic fever and acute tonsillitis in terms of adequate antibiotic therapy, good oral hygiene and awareness about the symptoms of RHD are very import aspects to protect against RHD.