ICD 10 Codes = I09.0 | I09.9 | I01.0-2 | I01.8-9
Description
These are chronic sequelae of rheumatic fever consisting of valvular damage, usually involving left heart valves, with progression and complications.
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.
OR
Phenoxymethylpenicillin, oral, 500 mg 12 hourly for 10 days.
Severe penicillin allergy (Z88.0), Macrolide, e.g.:
Azithromycin, oral, 500 mg daily for 3 days.
For arthritis and fever, NSAID, e.g.:
Ibuprofen, oral, 400 mg 8 hourly with meals.
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.
Benzathine benzylpenicillin (depot formulation), IM, 1.2 MU 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.
OR
Phenoxymethylpenicillin, oral, 250 mg 12 hourly.
Severe penicillin allergy (Z88.0), use macrolide, e.g.:
Azithromycin, oral, 250 mg daily.
Prophylaxis for infective endocarditis: see Infective endocarditis section.
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.
More reading on rheumatic heart disease is here.