Medical Management of Rheumatic Heart Disease: A Systematic Review of the Evidence

E. Anne Russell, Warren Walsh, Ben Costello, Alex J A McLellan, Alex Brown, Christopher Reid, Lavinia Tran, Graeme Maguire

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Abstract: Rheumatic heart disease (RHD) is an important cause of heart disease globally. Its management can encompass medical and procedural (catheter and surgical) interventions. Literature pertaining to the medical management of RHD from PubMed 1990–2016 and via selected article reference lists was reviewed. Areas included symptom management, left ventricular dysfunction, rate control in mitral stenosis, atrial fibrillation, anticoagulation, infective endocarditis prophylaxis, and management in pregnancy. Diuretics, angiotensin blockade and beta-blockers for left ventricular dysfunction, and beta-blockers and If inhibitors for rate control in mitral stenosis reduced symptoms and improved left ventricular function, but did not alter disease progression. Rhythm control for atrial fibrillation was preferred, and where this was not possible, rate control with beta-blockers was recommended.
Anticoagulation was indicated where there was a history of cardioembolism, atrial fibrillation, spontaneous left atrial contrast, and mechanical prosthetic valves. While warfarin remained the agent of choice for mechanical valve implantation, non-vitamin K antagonist oral anticoagulants may have a role in RHD-related AF, particularly with valvular regurgitation. Evidence for
anticoagulation after bioprosthetic valve implantation or mitral valve repair was limited. RHD patients are at increased risk of endocarditis, but the evidence supporting antibiotic prophylaxis before procedures that may induce bacteremia is limited and recommendations vary. The management of RHD in pregnancy presents particular challenges, especially regarding decompensation
of previously stable disease, the choice of anticoagulation, and the safety of medications in both pregnancy and breast feeding.
Original languageEnglish
Pages (from-to)187
Number of pages195
JournalCardiology in review
Volume26
Issue number4
DOIs
Publication statusPublished - Aug 2018

Keywords

  • rheumatic heart disease
  • medical management
  • Indigenous health

Cite this