Rheumatic fever - RAA - Treatment

Primary prophylaxis.Does detection and treatment of streptococcal anginelor energetic the whole population, especially in the age group 3-21 years in order to prevent acute rheumatic first spurt and stop the extension of infection to other people.
Treatment of streptococcal angina is made with:Penicillin V-1. 600. 000 IU / day for 10 days administered 30 minutes before meals orPenicillin G-1. 000. 000 IU / day for 10 daysPenicillin-benzatin-1. 200. Single intramuscular injection or 000 IUIn case of allergy, erythromycin, cephalosporin, amoxicillin-clavulanate, dicloxacillin, other macrolides.
Secondary prophylaxis.To prevent recurrence of rheumatic fever should be mandatory remediation outbreaks of infection with antibiotics:Penicillin-benzatin-1. 200. 000 IU a single intramuscular injection in developed countries (2/luna in third world countries), until the age of 25 years in children and 30 adults.Penicillin V, 125-250 mg twice a day, although preferred for convenience of administration is less effective-In case of allergy can be used erythromycin, sulfadiazine.Risk of recurrence in administration per os is 25 times higher than in the IM.
Surgical Drainage of outbreaks of infection-tonsillectomy under antibiotic protection.
Forms of arthritis with or without carditis without cardiomegaly.It is treated with aspirin 100 mg / day in 4-6 divided doses per day until the patient becomes afebril postprandial and asymptomatic. It then decreased to 75 mg / kg / day, 4-6 weeks before biological normalization.
Side effects of aspirin include:-Allergic rash, heartburn, nausea, vomiting, acid regurgitationDigestive-microhemoragii, haematemesis, melena- Salicylic drunkenness. "
Contra hyperacid in gastritis, peptic ulcer, hiatal hernia, bleeding disorders, liver failure, kidney failure.
Forms of cardiomegaly cusau without decompensation.It is treated with prednisone 2 mg / kg / day at least 2 weeks until ESR decreased to 30 mm / h, with declining doses withdrawal to avoid rebound site. Steroid therapy decreases myocardial interstitial edema and limit heart damage.
Associated Aspirin-75 mg / kg / day introduced after two weeks and another 4 weeks after stopping prednisone.
In case of rebound that occurs 3-5 weeks after withdrawal is advisable not to resume treatment if these were discrete.Otherwise restore the last dose corticosteroid therapy using triple.Rebound's manifested by fever, poliartralgii / arthritis, increased ESR and CRP, the occurrence of murmurs, pericarditis or cardiac decompensation.
Treatment of heart failure.This can yield if treated early, at rest, dietary salt restriction, corticosteroids. Otherwise therapy is associated digitalo-diuretic and vasodilator.
Treatment choreei Sydenham.Benefits of psychotherapy, sedatives, anticonvulsants: chlorpromazine, valproate and neuroleptics: haloperidol.
Arrhythmias fails to corticotherapy, rarely impose on antiarrhythmic medication.
Surgery.In case of failure of medical, surgical correction may be saving valve.
Comisurotomia dark heart.Assume transarterial digital fracture or with a transventricular dilator. It is indicated in cases with flexible valves, calcifying, cordage nescurtate with and without atrial thrombosis. 1 shows the perioperative mortality. 5% restenozare 10% at 5 years and 60% survival at 10 years 18 years 90%.
Comisurotomia open heart.It is accurate but requires extracorporeal circulation and cardioplegia.
Artificial and biological valve prosthesis is a useful method because it improves palliative but net and prolongs its life quality.
Percutaneous transluminal valvuloplasty.Percutaneous involves placing a catheter equipped with a bubble that will swell transvalvular radiological control, until the disappearance of mitral indentations.
Other surgical techniques include:Anuloplastie-rigid or semirigid prosthetic ringCorner-suture-Shortening, elongation, or reimplantation of cordageCordage-sutures and valves.
Hygienic-dietary regime.Forms of arthritis with or without carditis but without cerdiomegalie require bed rest for three weeks in hospital conditions.Card forms and cardiomegaly and / or heart failure requiring bed rest, supervised and controlled sodium diet prior to clearing.