RHEUMATIC HEART DISEASE

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These are chronic sequelae of rheumatic fever consisting of valvular damage, usually involving left heart valves, with progression and complications.

GENERAL MEASURES 

Acute stage: bed rest and supportive care.

Patient education.

Intensive health education for prevention of sore throats.

MEDICINE TREATMENT 

Acute rheumatic fever

For eradication of streptococci in throat:

  • Benzathine benzylpenicillin (depot formulation), IM, 1.2 million units as a single dose. OR
  • Phenoxymethylpenicillin, oral, 500 mg 12 hourly for 10 days.
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Penicillin allergy:   Macrolide, e.g.:

  • Erythromycin, oral, 250 mg 6 hourly for 10 days.

Prevention of recurrent rheumatic fever 

All patients with confirmed rheumatic fever and no rheumatic valvular disease – treat until 21 years of age.

All patients with confirmed rheumatic fever and rheumatic valvular disease – treat until 35 years of age.

  • Benzathine benzylpenicillin (depot formulation), IM, 1.2 million units every 3–4 weeks. OR
  • Phenoxymethylpenicillin, oral, 250 mg 12 hourly.
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Penicillin allergy:

  • Erythromycin, oral, 250 mg 12 hourly

Prophylaxis for infective endocarditis See Endocarditis, infective.

REFERRAL 

»     Where surgery is contemplated.

»      Management of intractable heart failure or other non-responding complications.

»      Pregnancy.

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