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rheumatic heart disease
Epidemiology:
- affects mostly children 5-15 years of age,
- may also occur in adults, especially in crowded conditions
Pathology:
- carditis
- valvular heart disease
- mitral valve most commonly involved
- mitral valve stenosis
- thickening & fusion of mitral valve leaflets [3]
- mitral regurgitation
Laboratory:
- see rheumatic fever
Special laboratory:
- EKG (PR prolongation)
- echocardiogram
Management:
- also see rheumatic fever
- prednisone 40-60 mg QD
a) useful for controlling pericarditis & CHF of acute rheumatic fever
b) no effect on residual heart disease
- prophylaxis (documented rheumatic fever with vavlular sequellae)
- long-term prophylactic penicillin for at least 10 years after last episode or until at least age 40 (whichever is longer) [3]
- benzathine penicillin G 1.2 million units IM every 4 weeks
- erythromycin 100-250 mg PO BID
- sulfadiazine 0.5-1 g PO QD
- erythromycin 100-250 mg PO BID
- prophylaxis for bacterial endocarditis prior to surgical procedures
General
rheumatic fever
valvular heart disease
carditis
References
- World Heart Fedaration: Rheumatic Heart Disease
http://www.world-heart-federation.org/press/fact-sheets/rheumatic-heart-disease/
- Chin TK and Berger S
eMedicine: Pediatric Rheumatic Heart Disease
http://emedicine.medscape.com/article/891897-overview
- Otto CM et al
2020 ACC/AHA Guideline for the Management of Patients With Valvular
Heart Disease. A Report of the American College of Cardiology/American
Heart Association Joint Committee on Clinical Practice Guidelines.
Circulation 2021;143:e00
PMID: 33332150
https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000923