The disease is spread by various Amblyomma ticks, and has a large economic impact on cattle production in affected areas.

In Trichardt's notes he recorded that a majority of the surrounding sheep died approximately three weeks after a large tick infestation was observed.

Major areas of concern for the disease also include Madagascar, Mauritius, Zanzibar, the Comoros Islands, and Sao Tomé.

[9][10][11] The South African buffalo, bleskbok, black wildebeest, helmeted guinea fowl, leopard tortoise and scrub hare are known to host heartwater without symptoms and act as a tick reservoir.

On post mortem examination, a light yellow transudate that coagulates on exposure to air is often found within the thorax, pericardium, and abdomen.

Pulmonary oedema and mucosal congestion are regularly seen along with frothy fluid in the airways and cut surfaces of the lungs.

To definitively diagnose the disease, C. ruminantium must be demonstrated either in preparations of the hippocampus under Giemsa staining or by histopathology of brain or kidney.

In areas endemic for heartwater, the use of dips against other ticks of domestic animals, such as Rhipicephalus (Boophilus) and Hyalomma species is likely, and this will usually contribute to control of vectors of E. ruminantium.