From the Guidelines
For rheumatic fever, you should consult a cardiologist, as they have the expertise to diagnose and manage this inflammatory disease that can develop after an untreated strep throat infection, and their involvement is crucial in preventing long-term heart damage, as recommended by the most recent guidelines 1. The management of rheumatic fever involves a comprehensive approach, including diagnosis, treatment, and prevention of recurrence.
- The primary care physician may initially evaluate the patient but will likely refer them to a cardiologist for specialized care.
- Treatment typically involves antibiotics like penicillin to eliminate any remaining streptococcal bacteria, along with anti-inflammatory medications such as aspirin or corticosteroids for severe cases.
- Long-term preventive antibiotic therapy is essential to prevent recurrence and heart damage, often continuing for 5-10 years or longer depending on severity, as outlined in the guidelines 1.
- The decision to discontinue prophylaxis or to reinstate it should be made after discussion with the patient of the potential risks and benefits and careful consideration of the epidemiological risk factors, as recommended by the American Heart Association 1.
- The cardiologist will also monitor the patient's heart health and adjust the treatment plan as needed to prevent long-term heart damage, such as rheumatic heart disease, which can lead to significant morbidity and mortality if left untreated 1.
From the Research
Diagnosis and Management of Rheumatic Fever
A patient with rheumatic fever should consult a healthcare professional, such as a primary care physician, cardiologist, or rheumatologist, for proper diagnosis and management 2, 3.
Importance of Secondary Prophylaxis
Secondary prophylaxis with antibiotics is crucial in preventing recurrent episodes of rheumatic fever and reducing the risk of developing rheumatic heart disease 4, 2.
Role of Healthcare Providers
Primary healthcare providers play a vital role in identifying acute rheumatic fever, ensuring adherence to treatment, and providing secondary prophylaxis with antibiotics 2.
High-Risk Populations
Certain populations, such as children from low-income families, Aboriginal and Maori populations, and other disadvantaged groups, are at a higher risk of developing rheumatic fever and should be closely monitored 5, 2, 3.
Latest Developments in Diagnosis and Treatment
The revised Jones criteria and World Heart Federation guidelines have improved the diagnosis and management of rheumatic fever and rheumatic heart disease 6.
Key Considerations
- Prompt recognition and treatment of streptococcal pharyngitis are essential in preventing rheumatic fever 5, 3
- Long-term antibiotics can reduce the risk of recurrence of rheumatic fever and progression to rheumatic heart disease 4
- Healthcare providers should be aware of the latest developments in diagnosis and treatment to provide optimal care for patients with rheumatic fever 6