salicylates and Rheumatic-Heart-Disease

Rheumatic fever and rheumatic heart disease continue unabated in most of the developing nations, affecting young individuals. Focal outbreaks of smaller magnitude have also been reported since mid 1980s from industrialized western nations, where this disease had almost disappeared. Introduction of penicillin in mid 1940s had markedly changed the natural history of rheumatic fever, although the incidence of rheumatic fever declined in developed nations before that, due to better living conditions. Treatment of rheumatic fever chiefly involves use of antibiotics (penicillin) to eradicate streptococci, and anti-inflammatory drugs like salicylates or corticosteroids. Patients with severe carditis, congestive heart failure and/or pericarditis are best treated with corticosteroids as these are more potent anti-inflammatory agents than salicylates. Salicylates may be sufficient for cases with mild or no carditis. The treatment must be continued for 12 weeks. Several studies have shown that valvular regurgitation, and not myocarditis, is the cause of congestive heart failure in active rheumatic carditis. Therefore surgery with mitral valve replacement or repair is indicated in cases with intractable hemodynamics due to mitral regurgitation. Development of chronic valvular lesion after an episode of rheumatic fever is dependent upon presence or absence of carditis in the previous attack and compliance with secondary prophylaxis. Recurrences due to inadequate penicillin prophylaxis are responsible for hemodynamically significant chronic valvular lesions requiring surgery.

Topics: Adrenal Cortex Hormones; Humans; Myocarditis; Rheumatic Heart Disease; Salicylates

Topics: Anti-Bacterial Agents; Bacterial Vaccines; Digitalis Glycosides; Humans; Immunoglobulins; Mitral Valve; Muramidase; Proteins; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Steroids

Topics: Acylation; Adolescent; Aminopyrine; Animals; Antipyrine; Aspirin; Biotransformation; Brain; Dogs; Ephedrine; Female; Gastric Mucosa; Glucuronates; Haplorhini; Humans; Hydrogen-Ion Concentration; Hydrolysis; Intestinal Absorption; Kidney; Kinetics; Liver; Male; Placenta; Pregnancy; Quinine; Rats; Rheumatic Heart Disease; Salicylamides; Salicylates; Secobarbital; Thiopental

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Antibiotics, Antitubercular; Dermatologic Agents; Humans; Japan; Rheumatic Heart Disease; Salicylates

Topics: Adrenocorticotropic Hormone; Anti-Inflammatory Agents; Aspirin; Child; Cortisone; Digitalis Glycosides; Electrocardiography; Heart Failure; Humans; Injections, Intramuscular; Penicillin G Benzathine; Physical Exertion; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Streptococcal Infections; Streptococcus; Virulence

Topics: Adolescent; Adrenal Cortex Hormones; Anti-Bacterial Agents; Antistreptolysin; Arthritis, Rheumatoid; Blood Proteins; C-Reactive Protein; Child; Chorea; Dermatology; Humans; Mucoproteins; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Serologic Tests

A 28-year-old man with extensive travel history to developing countries was hospitalised for intermittent sharp chest pains, worst when supine and with inspiration. Two weeks prior to presentation, he had suffered a flu-like illness with a sore throat, which was resolving. Physical examination was notable for mild fever and tachycardia with cervical lymphadenopathy and painful bilateral knee and wrist effusions. Cardiac auscultation was remarkable for a soft early-peaking systolic murmur over the aortic area with a decrescendo early diastolic murmur along the left sternal edge. There was mild leucocytosis, elevation of serum troponin and acute-phase reactants with an ECG showing sinus tachycardia. Echocardiographic windows were extremely limited but suggested the presence of pericardial effusion and aortic regurgitation. Cardiac MRI was performed (figure 1). Viral, microbiological and autoimmune testing was remarkable only for significant elevation of antistreptolysin-O titres (1450 IU rising to 1940 IU, normal <200 IU). Pericardiocentesis revealed an exudative effusion, which was negative by cytology and microbiological analysis, including for tuberculosis and fungi.. The most appropriate next step is? Coronary angiographyEndomyocardial biopsyTreatment with colchicine for 3 monthsTreatment with corticosteroidsTreatment with high-dose salicylates and long-term penicillinFor the answer see page 808For the question see page 769.

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Chest Pain; Drug Administration Schedule; Humans; Magnetic Resonance Imaging, Cine; Male; Penicillins; Pericardial Effusion; Rheumatic Heart Disease; Salicylates; Time Factors; Treatment Outcome

Topics: Adrenal Cortex Hormones; Controlled Clinical Trials as Topic; Echocardiography; Follow-Up Studies; Heart Auscultation; Humans; Meta-Analysis as Topic; Myocarditis; Rheumatic Heart Disease; Salicylates; Sensitivity and Specificity

Topics: Aspirin; Child; Griseofulvin; Humans; Male; Rheumatic Heart Disease; Salicylates; Salicylic Acid; Tinea Capitis

Topics: Adrenal Cortex Hormones; Adult; Child; Drug Therapy, Combination; Humans; Penicillin G Benzathine; Penicillins; Pyrazoles; Recurrence; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Anti-Inflammatory Agents, Non-Steroidal; Humans; Phenacetin; Phenylbutazone; Phenylpropionates; Rheumatic Heart Disease; Salicylates

While rheumatic fever is relatively uncommon except where there are poor and crowded living conditions, sporadic acute attacks continue to occur in a family or pediatric medical practice. The physician's role in management of the sore throat in the diagnosis of suspected cases of rheumatic fever and in follow-up for continued prophylaxis is discussed. The frequency of admissions and presenting features of 159 patients with acute rheumatic fever is reviewed. Continued surveillance is required if we are to achieve a further reduction in attack rate and complications.

Topics: Acute Disease; Adolescent; Antistreptolysin; Arthritis, Juvenile; Arthritis, Rheumatoid; Child; Child, Preschool; Diagnosis, Differential; Heart Murmurs; Heart Valve Diseases; Humans; Manitoba; Penicillins; Prednisone; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Streptococcal Infections; Streptococcus; Time Factors

Topics: Arthritis; Humans; Penicillin G Benzathine; Penicillin G Procaine; Prednisone; Recurrence; Rheumatic Fever; Rheumatic Heart Disease; Rheumatic Nodule; Salicylates; Serum Sickness; Streptococcus

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Amino Acids; Blood Circulation; Female; Humans; Male; Middle Aged; Recurrence; Rheumatic Heart Disease; Salicylates

Topics: Adrenal Cortex Hormones; Aminopyrine; Humans; Penicillins; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Streptococcal Infections; Sulfonamides

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Arabia; Child; Erythema Nodosum; Female; Humans; Male; Middle Aged; Myocarditis; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Adrenal Cortex Hormones; Aminopyrine; Anti-Bacterial Agents; Humans; Immunoglobulins; Indomethacin; Lymphocyte Activation; Pyrazoles; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Streptococcal Infections; Streptolysins; Vasodilator Agents

Topics: Anti-Bacterial Agents; Cortisone; Endocarditis, Subacute Bacterial; Heart Valve Diseases; Humans; Penicillins; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Time Factors

Topics: Adrenal Cortex Hormones; Child; Chorea; Humans; Penicillins; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Adrenal Cortex Hormones; Age Factors; Child; Child, Preschool; Chorea; Endocarditis; Female; Heart Failure; Heart Valve Diseases; Humans; Male; Myocarditis; Penicillins; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Sex Factors

Topics: Adolescent; Child; Female; Humans; Iran; Male; Prednisone; Retrospective Studies; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Sex Factors; Socioeconomic Factors

Topics: Adrenal Cortex Hormones; Blood Coagulation; Fibrinolysis; Heparin; Humans; Rheumatic Heart Disease; Salicylates

Topics: Arthritis, Rheumatoid; Collagen Diseases; Humans; Lupus Erythematosus, Systemic; Prednisolone; Pyrazoles; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Scleroderma, Systemic; Triamcinolone

Topics: Adrenal Cortex Hormones; Follow-Up Studies; Humans; Pyrazoles; Rheumatic Heart Disease; Salicylates; Time Factors

Topics: Aspirin; Child; Child, Preschool; Humans; Penicillins; Prednisone; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Adolescent; Age Factors; Anti-Bacterial Agents; Child; Child, Preschool; Female; Humans; Male; Poland; Rheumatic Diseases; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Sex Factors; Steroids

Topics: Adrenal Cortex Hormones; Child; Child, Preschool; Female; Humans; Italy; Male; Penicillin G; Penicillin G Benzathine; Pyrazoles; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Anti-Bacterial Agents; Humans; Israel; Italy; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Socioeconomic Factors; Sulfonamides; United Kingdom; United States

Topics: Age Factors; Analgesics; Antistreptolysin; Blood Sedimentation; Chorea; Humans; Lanatosides; Penicillins; Phenylbutazone; Prednisone; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Strophanthins; Sulfonamides

Topics: Adolescent; Arthritis, Juvenile; Child; Dexamethasone; Female; Humans; Injections, Subcutaneous; Male; Nephrosis, Lipoid; Nicotinic Acids; Pericardium; Postoperative Complications; Rheumatic Heart Disease; Salicylates

Topics: Adrenal Cortex Hormones; History of Medicine; History, 19th Century; History, 20th Century; Penicillins; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Adrenal Cortex Hormones; Chloroquine; Humans; Pyrazoles; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Adrenal Cortex Hormones; Cardiovascular Agents; Corticosterone; Drug Therapy; Glucocorticoids; Humans; Pregnadienes; Rheumatic Heart Disease; Salicylates

Topics: Humans; Rheumatic Heart Disease; Salicylates

Topics: Adolescent; Adrenal Cortex Hormones; Aminopyrine; Child; Drug Therapy; Endocarditis; Humans; Infant; Myocarditis; Pericarditis; Rheumatic Heart Disease; Salicylates

Topics: Adolescent; Blood Sedimentation; C-Reactive Protein; Child; Heart Failure; Humans; Rheumatic Heart Disease; Salicylates; Statistics as Topic; Steroids

Topics: Adolescent; Adrenal Cortex Hormones; Aortic Valve Stenosis; Cardiac Surgical Procedures; Child; Drug Therapy; Electrocardiography; Humans; Mitral Valve Stenosis; Penicillins; Pericarditis; Postoperative Complications; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Sulfonamides; Thoracic Surgery; Tricuspid Valve Stenosis

Topics: Adrenal Cortex Hormones; Cardiac Surgical Procedures; Drug Therapy; Humans; Penicillins; Rest; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Thoracic Surgery

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Arthritis, Rheumatoid; Fever; Humans; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Statistics as Topic; Streptococcal Infections; Tonsillectomy

Topics: Aged; Electrocardiography; Geriatrics; Humans; Penicillins; Phenylbutazone; Potassium; Potassium Deficiency; Prednisolone; Rheumatic Heart Disease; Salicylates; Strophanthins; Thiamine

Topics: Adrenal Cortex Hormones; Child; Drug Therapy; Humans; Penicillins; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Endocarditis; Endocarditis, Bacterial; Rheumatic Heart Disease; Salicylates

Topics: Adrenocorticotropic Hormone; Cortisone; Dexamethasone; Humans; Myocarditis; Penicillins; Phenylbutazone; Prednisone; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Streptococcal Infections; Triamcinolone

Topics: Follow-Up Studies; Humans; Myocarditis; Rheumatic Heart Disease; Salicylates; Salicylic Acid

Topics: Adolescent; Aortic Valve; Aortic Valve Stenosis; Child; Follow-Up Studies; Heart Valve Diseases; Humans; Mitral Valve; Mitral Valve Stenosis; Myocarditis; Rheumatic Heart Disease; Salicylates

Topics: Adrenal Cortex Hormones; Myocarditis; Rheumatic Diseases; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Adrenal Cortex Hormones; Heart Diseases; Pericarditis; Rheumatic Heart Disease; Salicylates

Topics: Adrenocorticotropic Hormone; Aspirin; Cortisone; Myocarditis; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Anticoagulants; Rheumatic Heart Disease; Salicylates

Topics: Glycoproteins; Humans; Rheumatic Heart Disease; Salicylates

Topics: Humans; Rheumatic Fever; Rheumatic Heart Disease; Salicylanilides; Salicylates; Transaminases

Topics: Blood Coagulation; Humans; Prothrombin; Rheumatic Heart Disease; Salicylanilides; Salicylates

Topics: Adrenocorticotropic Hormone; Cortisone; Rheumatic Fever; Rheumatic Heart Disease; Salicylanilides; Salicylates

Topics: Adjuvants, Immunologic; Adjuvants, Pharmaceutic; Pantothenic Acid; Rheumatic Heart Disease; Salicylates; Salicylic Acid

Topics: Adrenocorticotropic Hormone; Cortisone; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Chronic Disease; Cortisone; Myocarditis; Recurrence; Rheumatic Heart Disease; Salicylates

Topics: Anti-Bacterial Agents; Cortisone; Endocarditis; Humans; Rheumatic Heart Disease; Salicylates

Topics: Humans; Lung Diseases; Myocarditis; Pulmonary Edema; Rheumatic Heart Disease; Salicylates; Sodium Salicylate

Topics: Ascomycota; Bulgaria; Communication; Heart Diseases; Humans; Rheumatic Diseases; Rheumatic Heart Disease; Salicylates

Topics: Analgesics; Cortisone; Endocarditis; Endocarditis, Bacterial; Maintenance; Phenylbutazone; Pyrazoles; Rheumatic Heart Disease; Salicylates

Topics: Benzoates; Rheumatic Heart Disease; Salicylates; Sodium Benzoate

Topics: Electrocardiography; Rheumatic Heart Disease; Salicylates

Topics: Anti-Bacterial Agents; Cortisone; Dermatologic Agents; Myocarditis; Rheumatic Heart Disease; Salicylates

Topics: Cortisone; Rheumatic Heart Disease; Salicylates

Topics: Biomedical Research; Humans; Rheumatic Heart Disease; Salicylates; Sodium Salicylate

Topics: Child; Humans; Infant; Rheumatic Heart Disease; Salicylates; Sodium Salicylate

Topics: Adrenocorticotropic Hormone; Cortisone; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Adrenocorticotropic Hormone; Cortisone; Myocarditis; Rheumatic Heart Disease; Salicylates

Topics: Gentisates; Rheumatic Fever; Rheumatic Heart Disease; Salicylates; Sodium Salicylate

Topics: Rheumatic Heart Disease; Salicylates

Topics: Blood Sedimentation; Humans; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Cortisone; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Rheumatic Heart Disease; Salicylates

Topics: Acidosis; Benzoates; Edema; Gentisates; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Heart Diseases; Inactivation, Metabolic; Myocarditis; Rheumatic Fever; Rheumatic Heart Disease; Salicylates

Topics: Fever; Heart Valve Diseases; Humans; Rheumatic Fever; Rheumatic Heart Disease; Salicylates