(Jones Criteria, 1992 Update)

Primary prevention of rheumatic

fever
Antibiotic prophylaxis (secondary
prevention) to prevent recurrent
attacks of acute rheumatic fever
Treatment
 Treatment
Antibiotics to treat the acute strep infection

Long-term antibiotics to prevent recurrent strep infection

Steroids or no steroidal anti-inflammatory medicines to

ease inflammation in the heart and in other parts of the
body

diuretics if heart failure develops

Anti-inflammatory medicine for the management of fever

and arthritis symptoms
 possible complications of rheumatic heart disease?
Complications of rheumatic heart disease include:

Permanent heart damage

Acute or chronic heart valve disease

Heart failure

Infection in the heart (endocarditis)

 Complications of rheumatic heart disease include:

Permanent heart damage

Acute or chronic heart valve disease
Heart failure
Infection in the heart (endocarditis)
 Treatment

Long-term penicillin injections are effective in

preventing recurrent acute rheumatic fever attacks
and subsequent development of rheumatic heart
disease.
If a patient develops heart failure due to valve
disease, the patient should be placed on medical
therapy as tolerated for heart failure including ACE
inhibitors, diuretics, and beta blockers.
 Treatment

Treatment depends in large part on how much

damage has been done to the heart valves. In severe
cases, treatment may include surgery to replace or
repair a badly damaged valve.
Balloon valvotomy / commissurotomy
In some places balloon valvotomy can be used to
treat mitral stenosis.
This operation can be done by threading a
deflated balloon on wires up to the heart from a
cut in the groin.
The narrowed mitral valve is opened by gently
inflating a balloon inside the valve.
The procedure may need to be repeated some
years later.
Balloon valvotomy requires only a small cut in the
groin, this reduces costs and complications
compared with open surgical repair, providing a
safe and effective option for low resource
settings.
Valve repair
• Mitral valve repair is an open heart surgical procedure,
• Surgeons repair the shape and function of damaged valve
leaflets allowing for more normal blood flow.
• However, valve repair is technically more difficult than
valve replacement and can only be performed by surgeons
specialized in valve repair technique.
Valve replacement
• Heart valve replacement is an open heart surgical
procedure.

• Surgeons remove the damaged heart valve and replace it

with a mechanical prosthetic (metallic valve) or
• bioprosthetic valve (tissue valve).

• Bioprosthetic valve replacements cause fewer blood clot

complications than metal valves but are more likely to
wear out and require replacement.

• Mechanical valve replacement is associated with high risk

of embolism and haemorrhagic complications but usually
last for life.
Percutaneous mitral balloon valvuloplasty
-is the standard first-line therapy for cases of
rheumatic mitral stenosis in the absence of
regurgitation, arrhythmias and left atrial thrombus
 Prevention

Rheumatic heart disease can be prevented by

preventing strep infections or treating them with
antibiotics when they do occur.
 It’s important to take antibiotics as prescribed and
to complete them as instructed, even if you feel
better after a few days.