Group A streptococcus (GAS) infection can lead to acute rheumatic fever (ARF) and subsequently rheumatic heart disease. ARF primarily affects young Aboriginal and Torres Strait Islander individuals, with clinical features including arthritis, carditis, Sydenham’s chorea, erythema marginatum and subcutaneous nodules. Early identification and treatment of GAS pharyngitis and impetigo are crucial in preventing the development of ARF.