Detailed instructions on how to treat rheumatic heart disease by the Ministry of Health

The article was professionally consulted by Specialist Doctor II Nguyen Quoc Viet - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital. The doctor has more than 20 years of experience in the examination and treatment of cardiovascular diseases and Cardiovascular Interventions (Including angiography, dilation, stenting of coronary arteries, renal arteries...), placing temporary pacemakers , forever...

Rheumatic heart disease is a dangerous type of heart disease that causes many complications or more severe can lead to death for the patient. However, if the disease is detected and treated early and properly, it can be avoided or cured.

Rheumatic heart disease is an autoimmune inflammatory disease that occurs after a bacterial infection of the oropharynx. The causative organism is group A hemolytic streptococci. Within 2 to 3 weeks of oropharyngeal streptococcal infection, if not adequately treated, the disease can progress to rheumatic fever. Rheumatic heart disease is most common between the ages of 5 and 15, although it can occur in younger children and adults as well. The prevalence of the disease in boys and girls is the same.
Rheumatic heart disease will become dangerous if not treated in time. Rheumatic heart disease can cause serious complications in the brain, heart, joints, skin. In the heart, rheumatic fever leaves long-term consequences such as inflammation of the heart, thickening of the heart valves. Over time, it will lead to heart valve damage, heart failure, arrhythmia, stroke, and even death.

Clinical pharyngitis : Common before 1-2 weeks. Body as a whole: Patient has low fever or high fever; whole body fatigue, poor eating; possible cough, chest pain... Valve inflammation: Common new apical systolic murmur due to mitral regurgitation; mid-apical diastolic murmur (carey coomb), possibly due to increased T3 pitch; diastolic murmur at the base of the heart due to aortic regurgitation. Myocarditis : The heart rate is usually tachycardic, corresponding to an increase of 1 degree C – heart rate increases 30 to 35 beats/min Pericarditis : Blurry heart sounds, pericardial rub can be heard Arthritis : Common Common in small joints or large joints such as: Knees, ankles, elbows, wrists... joints are painful to move, limited movement, swollen-hot-red. Characteristics of arthritis: Responds very quickly to salicylates, when cured without leaving sequelae, without treatment, it also resolves itself after 4 weeks. Chorea (Sydenham): Due to damage to the central nervous system. The patient has movements in one or two limbs with the following characteristics: Wide amplitude, sudden, unconscious, increased when awake and decreased or stopped when focusing on something or sleeping. Chorea usually resolves after 4-6 weeks. Erythema (Besnier's rash): Erythema ring, haloed with rim diameter 1-2 mm, common on trunk, flanks, proximal extremities, absent on face. Ban disappeared after a few days. Meynet granules: These are floating particles under the skin with a diameter of about 5-10 mm, sticking to the bone base (elbows, knees...) and painless, appearing with arthritis and heart inflammation, disappearing after a few weeks. Heart failure (in case of severe rheumatic fever): The patient has difficulty breathing, dry cough, edema, enlarged liver, distended neck veins, moist rales in the lungs... ; increased fibrinemia; Protein C increased; Antistreptolysin O (ASLO): Elevated > 200 Todd units. Increases after infection with group A beta-hemolytic streptococci after 2 weeks, lasts for 3-5 weeks and then gradually decreases. Electrocardiogram: Grade I atrial-ventricular block is common. Sinus tachycardia. Atrial extrasystoles, ventricular extrasystoles... Cardiopulmonary : Can see enlarged heart, dark hilum... Echocardiogram: Result of stenosis, mitral regurgitation, aortic regurgitation.., may have pericardial effusion...

Currently, the treatment regimens for rheumatic heart disease are based on the cause of the disease, combining rest, antibiotics, anti-inflammatory, and symptomatic treatment.
Rest Table 1: Rest according to the degree of inflammation

Antibiotic treatment of rheumatic heart disease Need immediate treatment, sufficient dose and enough time to kill streptococci.
Currently, penicillin is still a commonly used drug because it is the most effective, there is no evidence of resistance to penicillin by streptococcus, and the drug is low cost and available on the market.
Table 2: Some common antibiotics to treat rheumatic heart disease

Anti-inflammatory: Depending on the severity of the disease
Polyarthritis: Assign Aspirin 100 mg/kg/day x 6 days. Aspirin 75 mg/kg/day x 2 weeks. Inflammation of the heart: Prednisolone 1-2 mg/kg/day x 2-3 weeks, if the erythrocyte sedimentation rate decreases, the dose should be reduced by 1-2 mg/week. Symptomatic treatment:
Heart failure treatment:
Heart support: Digoxin 0.25mg/day; Diuretics: Indication Furosemide 40 mg x 1-2 tablets/day (note: potassium replacement). Vasodilators: Perindopril 4 mg x 1 tablet/day or enalapril 5 mg x 1 tablet/day or captopril 25 mg x 1 tablet/day.

Although there are many dangerous complications, but basically rheumatic heart disease can be prevented through the following measures:
Always keep the living environment, clean the body, especially the nose and throat area regularly and clean. Keep the neck, chest, nose and throat warm in winter and eat enough nutrients to improve resistance. If the child has a sore throat, tonsillitis or sinusitis, it is necessary to take the child to a medical facility with an ear, nose and throat specialist for thorough treatment. When you see children aged 5-15 with sore throat many times, they have pain, swelling, redness in the joints, fatigue, chest tightness, shortness of breath or palpitations, pain in the heart area, or unusual symptoms. In terms of psychomotor problems, the hand dances and plays uncontrollably, it is necessary for the child to go to the doctor immediately for timely detection and treatment and prevention of rheumatic heart disease. When children have indications for vaccination, it is necessary to follow to prevent recurrence of rheumatic fever under the guidance of doctors. If not vaccinated, the disease will easily recur many times and leave more and more severe sequelae leading to irreversible heart failure, which is very dangerous to the child's life. Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading doctors, modern equipment and technology, but also stands out for its examination and consulting services. and comprehensive, professional medical treatment; civilized, polite, safe and sterile medical examination and treatment space.