Rheumatic heart disease most commonly manifests as rheumatic myocarditis, pericardial thickening, or pericardial effusion. The majority of patients also present with mitral valve stenosis and insufficiency, and some also have aortic valve stenosis and insufficiency. When patients have severe aortic valve stenosis or severe aortic valve insufficiency, it leads to insufficient blood supply from the aorta, causing inadequate coronary circulation, which then can lead to angina.