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Rheumatic heart disease involves a ( type 2 hypersensitivity, type 1 hypersensitivity, type 4 hypersensitivty ) reaction. The target antigen is the cell wall antigen of the ( group A strep, group B strep, group C strep ). This leads to ( sterile, infective ) vegetations and activation of macrophages and cytokines which can cause damage to the heart valves.