Rheumatic heart disease (RHD) is a common cardiovascular problem in developing countries. The study was included 100 RHD pediatric and conducted in the rheumatic heart disease clinic at Alexandria University Children's Hospital.Environmental factors affect the prevalence of ARF by increasing exposure to S. pyogenes infections. A major environmental factor that increases, the likelihood of ARF is household crowding, which facilitates the spread of S. pyogenes infections. In addition, it has been shown that ARF and RHD are more prevalent in rural and remote areas as well as in urban slums, but this likely reflects other risk factors, such as greater household crowding due to low socioeconomic status or limited access to medical resources.The aim of this work was to study the socioeconomic status in patients with rheumatic heart disease in Alexandria University Children's Hospital, identify the most relevant risk factors to disease occurrence, assess the extent of contribution of environmental factors versus familial factors and define the risk factors which may be more related to RF recurrences.