Treatment

Abstract

It is ironic that the field most important to a clinician, treatment, is the one that can boast the least progress. 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 the need for perennial anticoagulation is bothersome. Most important perhaps from a worldwide standpoint, cardiac surgery is often not available or difficult to get to, or rudimentary in many parts of the world — the very parts, in fact, where the need is greatest. 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. For such surgical therapy, as for the medical therapy of established rheumatic heart disease, the reader is referred to standard textbooks. We will deal here with the medical management of the acute attack.