One hundred fourteen patients with rheumatic heart disease were seen between January 1994 and January 1995 at Gondar College of Medical Sciences Teaching Hospital. These patients were prospectively described using a prepared study protocol consisting of socio-demographic variables, clinical findings and laboratory tests. The mean and median age of the patients were 23 +/- 8 years and 22 years, respectively, (range = 5-50 years). About 66% of the patients were females with female to male ratio of 1.9:1. Eighty five cases (74.6%) were on follow up with mean and median duration of 4.32 +/- 4.5 years and 3 years, respectively (range = 1-20 years). The rest (25.4%) of the patients were new. History findings suggestive of rheumatic fever were obtained in 26% of the patients. Six patients (5.3%) had siblings with similar illness. Frequently encountered valve lesions were combined mitral regurgitation and stenosis seen in 29 (25.4%), followed by pure mitral stenosis in 25 (21.9%) and mitral regurgitation in 21 (18.4%). The commonest arrhythmia was atrial fibrillation, observed in 22.8% of the cases. Recurrence of rheumatic fever occurred in 11 patients (9.6%) over the study period. Of these, five were regularly taking a four weekly Banzanthine penicillin injections. The functional classes of patients according to the New York Heart Association's classification were 17%, 25%, 26% and 32% for classes I, II, III and IV, respectively. There were 85 episodes of decompensations. The commonest precipitating factor was drug discontinuation followed by infection and arrhythmia. Most episodes have multiple causes for deterioration. Critical evaluation and education of patients during follow up is recommended.