Management of Rheumatic

Heart Disease

The goal of the management of rheumatic

heart is to prevent disease progression and
to avoid or at least delay valve surgery
management
● The key elements of the effective management of rheumatic heart disease, are
initial assessment, education and referral to a medical or heart specialist if
applies.
● In case of heart failure, it is recommended to admit the patient for bedrest and
treatment of heart failure with Duratex and ACE inhibitors,
● management of atrial fibrillation with digoxin and anticoagulation.
● Regular medical and echocardiographic review.
● Secondary prophylaxis is very important to prevent the recurrence of acute
rheumatic fever, which come to damage more the heart valves.. It is also needed
to plan for regular dental care, and also contraception especially for female
adolescents.
treatment
Primary prevention of rheumatic heart disease centers on
speedy recognition and treatment of group A
streptococcal pharyngitis to prevent the development of
acute rheumatic fever. Intramuscular benzathine
penicillin G is the most widely used antibiotic to treat
group A streptococcal pharyngitis.

If a patient has a proven diagnosis of acute rheumatic

fever, the goal of treatment is to suppress the
inflammatory response to minimize the effects of
inflammation on the heart and joints.

According to the World Heart Federation, the only cost-

effective approach to preventing the progression of
rheumatic heart disease is secondary prophylaxis in the
form of penicillin injections every 3 to 4 weeks to prevent
recurrent group A streptococcal infection that causes
recurrent episodes of acute rheumatic fever.
mitral balloon valvuloplasty
Several diseases have been acknowledged as pathological causes
for mitral valve stenosis (MS), of which rheumatic heart disease is the
most prevalent. Percutaneous mitral balloon valvuloplasty is the
standard first-line therapy for cases of rheumatic mitral stenosis.

Balloon valvotomy is used to increase the opening of a narrowed

(stenotic) valve, This balloon valvotomy procedure can be performed
on the mitral, tricuspid, aortic or pulmonary valves.

Long, slender tubes called catheters are first placed into blood
vessels in the groin and guided into the heart’s chambers.

The cardiologist then creates a tiny hole in the wall between the upper
two chambers of the heart. This hole provides an opening for the
cardiologist to access the left atrium with a special catheter that has a
balloon at the tip.

The catheter is positioned so the balloon tip is directly inside the

narrowed valve. The balloon is inflated and deflated several times to
widen the valve opening.
reference
● Kumar RK, Antunes MJ, Beaton A, et al. Contemporary Diagnosis and Management of Rheumatic
Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart
Association [published correction appears in Circulation. 2021 Jun 8;143(23):e1025-e1026].
Circulation. 2020;142(20):e337-e357.
● Ralph AP, Noonan S, Wade V, Currie BJ. The 2020 Australian Guideline for Prevention, Diagnosis and
Management of Acute Rheumatic Fever and Rheumatic Heart Disease. Vol 214.; 2021.
doi:10.5694/mja2.50851
● Fawzy ME. Mitral balloon valvuloplasty. J Saudi Heart Assoc. 2010;22(3):125-132.
doi:10.1016/j.jsha.2010.04.013