Treatment

Abstract

It is ironic that the field most important to a clinician—treatment—is the one that can boast the least progress. Indeed, there have been no significant advances in treatment since the first edition of this book was published. There is still no means to prevent damage to the heart when carditis occurs in the rheumatic patient. To be sure, surgery has provided relief for the most disabling end-results of carditis, but the outcomes are often imperfect, the operative mortality rate not negligible, and, whenever prostheses are used, the postoperative risk of infective endocarditis is significant, and perennial anticoagulation is bothersome and not without risk. Nevertheless, surgical therapy of rheumatic heart disease has been a blessing to many, and should be considered in severe cases even when “rheumatic activity” seems to linger on^{1, 2}. There are now many more centers around the world doing cardiac surgery than there were seven years ago, but there is still a considerable backlog of patients in developing countries with advanced heart disease who remain on waiting lists for long periods of time. For surgical therapy, as for the medical therapy of established rheumatic heart disease, the reader is referred to textbooks of cardiology. We will deal here with the medical management of the acute attack.