If the patient has rheumatic heart disease, especially mitral regurgitation or mitral stenosis, this condition can occur. However, the rheumatoid factor may not necessarily be high, as the rheumatoid factor can lead to some cases of rheumatic heart disease, but it is not always elevated. Because this condition cannot be improved even with aggressive treatment, sometimes surgical treatment may still be needed. This is a type of congenital heart disease that can cause these conditions in patients. Rheumatic heart disease is mainly characterized by chest tightness, difficulty breathing, and a booming or mechanical murmur in the precordial area, all of which can occur, but the rheumatoid factor is not necessarily high.