Репост из: Medical Quotes: By Disease
📌 Rheumatic heart disease: Treatment
🔸 Introduction
Rheumatic heart disease (RHD) is a significant cause of cardiovascular morbidity and mortality, particularly in developing countries. It results from acute rheumatic fever and primarily affects the heart valves. Effective treatment strategies are crucial to manage symptoms, prevent disease progression, and improve patient outcomes.
🔸 Key Insights
Anti-inflammatory Treatment for Acute Rheumatic Fever:
· Corticosteroids and intravenous immunoglobulins show little evidence of benefit in reducing the risk of heart valve lesions in patients with acute rheumatic fever. The studies are outdated and have a substantial risk of bias, necessitating new randomized controlled trials (1).
Medical Management:
· Diuretics, angiotensin blockade, and beta-blockers are effective for symptom management and improving left ventricular function but do not alter disease progression (2).
· Rhythm control for atrial fibrillation is preferred, with beta-blockers recommended for rate control when rhythm control is not possible. Anticoagulation is indicated for patients with a history of cardioembolism, atrial fibrillation, spontaneous left atrial contrast, and mechanical prosthetic valves (2, 7).
Secondary Antibiotic Prophylaxis:
· Benzathine penicillin G (BPG) injections every four weeks are the cornerstone of secondary prevention, significantly reducing the risk of disease progression in children and adolescents with latent RHD (6,10).
· High rates of BPG prescription and adherence are observed among patients retained in care, but retention itself is a significant barrier (3).
Surgical and Catheter-Based Interventions:
· Definitive catheter and surgical interventions are the only treatments that can improve outcomes for patients with moderate or severe RHD. However, access to these interventions is limited in regions with high disease prevalence (4, 5, 8).
Management in Special Populations:
· Pregnancy poses high risks for women with RHD, requiring careful management of anticoagulation and monitoring of disease progression (4, 9).
· Patients with RHD are at increased risk of infective endocarditis, and antibiotic prophylaxis before procedures that may induce bacteremia is recommended, although evidence supporting this is limited (2, 10).
🔸 Conclusion
The treatment of rheumatic heart disease involves a combination of medical management, secondary antibiotic prophylaxis, and surgical interventions. While medications can manage symptoms and improve heart function, they do not halt disease progression. Secondary prophylaxis with benzathine penicillin G is crucial for preventing disease progression, especially in children and adolescents. Surgical and catheter-based interventions are necessary for severe cases but are often inaccessible in high-prevalence regions. Special considerations are required for managing RHD in pregnant women and preventing infective endocarditis. Overall, improving access to comprehensive care and retention in treatment programs is essential for better outcomes in RHD patients.
📖 References:
1. https://doi.org/10.1097/CRD.0000000000000185
2. https://doi.org/10.1002/14651858.CD003176.pub3
3. https://doi.org/10.1161/CIRCOUTCOMES.117.004037
4. https://doi.org/10.1016/j.pcl.2020.06.003
5. https://doi.org/10.1016/S0140-6736(16)00547-X
6. https://doi.org/10.1056/NEJMoa2102074
7. https://doi.org/10.1016/j.ahj.2020.03.018
8. https://doi.org/10.1016/b978-0-323-63982-8.00006-4
9. https://doi.org/10.1161/CIR.0000000000000921
10. https://doi.org/10.18773/austprescr.2022.034
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🔸 Introduction
Rheumatic heart disease (RHD) is a significant cause of cardiovascular morbidity and mortality, particularly in developing countries. It results from acute rheumatic fever and primarily affects the heart valves. Effective treatment strategies are crucial to manage symptoms, prevent disease progression, and improve patient outcomes.
🔸 Key Insights
Anti-inflammatory Treatment for Acute Rheumatic Fever:
· Corticosteroids and intravenous immunoglobulins show little evidence of benefit in reducing the risk of heart valve lesions in patients with acute rheumatic fever. The studies are outdated and have a substantial risk of bias, necessitating new randomized controlled trials (1).
Medical Management:
· Diuretics, angiotensin blockade, and beta-blockers are effective for symptom management and improving left ventricular function but do not alter disease progression (2).
· Rhythm control for atrial fibrillation is preferred, with beta-blockers recommended for rate control when rhythm control is not possible. Anticoagulation is indicated for patients with a history of cardioembolism, atrial fibrillation, spontaneous left atrial contrast, and mechanical prosthetic valves (2, 7).
Secondary Antibiotic Prophylaxis:
· Benzathine penicillin G (BPG) injections every four weeks are the cornerstone of secondary prevention, significantly reducing the risk of disease progression in children and adolescents with latent RHD (6,10).
· High rates of BPG prescription and adherence are observed among patients retained in care, but retention itself is a significant barrier (3).
Surgical and Catheter-Based Interventions:
· Definitive catheter and surgical interventions are the only treatments that can improve outcomes for patients with moderate or severe RHD. However, access to these interventions is limited in regions with high disease prevalence (4, 5, 8).
Management in Special Populations:
· Pregnancy poses high risks for women with RHD, requiring careful management of anticoagulation and monitoring of disease progression (4, 9).
· Patients with RHD are at increased risk of infective endocarditis, and antibiotic prophylaxis before procedures that may induce bacteremia is recommended, although evidence supporting this is limited (2, 10).
🔸 Conclusion
The treatment of rheumatic heart disease involves a combination of medical management, secondary antibiotic prophylaxis, and surgical interventions. While medications can manage symptoms and improve heart function, they do not halt disease progression. Secondary prophylaxis with benzathine penicillin G is crucial for preventing disease progression, especially in children and adolescents. Surgical and catheter-based interventions are necessary for severe cases but are often inaccessible in high-prevalence regions. Special considerations are required for managing RHD in pregnant women and preventing infective endocarditis. Overall, improving access to comprehensive care and retention in treatment programs is essential for better outcomes in RHD patients.
📖 References:
1. https://doi.org/10.1097/CRD.0000000000000185
2. https://doi.org/10.1002/14651858.CD003176.pub3
3. https://doi.org/10.1161/CIRCOUTCOMES.117.004037
4. https://doi.org/10.1016/j.pcl.2020.06.003
5. https://doi.org/10.1016/S0140-6736(16)00547-X
6. https://doi.org/10.1056/NEJMoa2102074
7. https://doi.org/10.1016/j.ahj.2020.03.018
8. https://doi.org/10.1016/b978-0-323-63982-8.00006-4
9. https://doi.org/10.1161/CIR.0000000000000921
10. https://doi.org/10.18773/austprescr.2022.034
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