Rheumatic Heart Disease

Description

General measures

Medicine treatment

Referral

---

I01.0-2/I01.8-9, I02.0, I05, I05.1, I06.0-2, I06.8-9, I09.0-2/I09.8-9

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.

LoE:IIIb^xcii

OR

• Amoxicillin, oral, 1000 mg (1 gram) 12 hourly for 10 days.

LoE:IIIb^xciii

Severe penicillin allergy: (Z88.0)

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

LoE:IIIb^xciv

For arthritis and fever:

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

LoE:IVb

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.

LoE:IVb^xcv

• Benzathine benzylpenicillin (depot formulation), IM, 1.2 million units 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.

LoE:IVb^xcvi

OR

• Phenoxymethylpenicillin, oral, 250 mg 12 hourly.

OR

• Amoxicillin, oral, 250 mg daily

LoE:IVb

Severe penicillin allergy: (Z88.0)

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

LoE:IVb

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.

Click here to access the pdf.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_01 November 2024

Chapter 3: Cardiovascular System_3.7 Rheumatic Heart Disease