Rheumatic heart disease

I09.0-2/I09.9/I01.0-2/I01.8-9

DESCRIPTION

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

GENERAL MEASURES

Acute stage of rheumatic fever: bed rest and supportive care.

MEDICINE TREATMENT

Acute rheumatic fever

For eradication of streptococci in throat:

  • Benzathine benzylpenicillin (depot formulation), IM, 1.2 MU as a single dose.
    • For benzathine benzylpenicillin, IM injection, dissolve benzathine benzylpenicillin 1.2 MU in 3.2 mL lidocaine 1% without adrenaline (epinephrine) or 3 mL water for injection.

LoEIII [66]

OR

  • Phenoxymethylpenicillin, oral, 500 mg 12 hourly for 10 days.

Severe penicillin allergy: (Z88.0)

  • Macrolide, e.g.:
    • Azithromycin, oral, 500 mg daily for 3 days.

LoEI [67]

For arthritis and fever:

  • NSAID, e.g.:
    • Ibuprofen, oral, 400 mg 8 hourly with meals.

LoEIII

Prevention of recurrent rheumatic fever

All patients with confirmed rheumatic fever and no persistent rheumatic valvular disease:

  • Treat for 10 years or until the age of 21 years, whichever is longer.

All patients with confirmed rheumatic fever and persistent rheumatic valvular disease:

  • Treat lifelong.

LoEIII [68]

  • Benzathine benzylpenicillin (depot formulation), IM, 1.2 MU every 3–4 weeks (preferred treatment).
    • For benzathine benzylpenicillin, IM injection, dissolve benzathine benzylpenicillin 1.2 MU in 3.2 mL lidocaine 1% without adrenaline (epinephrine) or 3 mL water for injection.

LoEIII [69]

OR

  • Phenoxymethylpenicillin, oral, 250 mg 12 hourly.

Severe penicillin allergy: (Z88.0)

  • Macrolide, e.g.:
    • Azithromycin, oral, 250 mg daily.

LoEIII

Prophylaxis for infective endocarditis

See: Endocarditis, infective.

REFERRAL

  • any patient with rheumatic valvular heart disease who requires a significant dose of diuretic to control fluid overload or who has had an episode of pulmonary oedema should be discussed with a specialist and referred for possible valve surgery.
  • pregnancy poses a particular problem in women with symptomatic rheumatic valvular heart disease and all should be referred for specialist consultation.