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With chronic rheumatic heart disease, patients develop valve stenosis with varying
degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic
rheumatic heart disease remains the leading cause of mitral valve stenosis and valve
replacement in adults in many countries including in Indonesia.
• Fever.
• Weight loss.
• Fatigue.
• Stomach pains.
• Joint inflammation - including swelling, tenderness, and redness over multiple
joints. The joints affected are usually the larger joints in the knees or ankles. The
inflammation "moves" from one joint to another over several days.
• Small nodules or hard, round bumps under the skin.
• A change in your child's neuromuscular movements (this is usually noted by a
change in your child's handwriting and may also include jerky movements).
• Rash (a pink rash with odd edges that is usually seen on the trunk of the body or
arms and legs).
Since rheumatic fever is the cause of rheumatic heart disease, the best treatment is to
prevent rheumatic fever from occurring. Oral penicillin V remains the drug of choice for
treatment of group A streptococcal pharyngitis. When oral penicillin is not feasible or
dependable, a single dose of intramuscular benzathine penicillin G is therapeutic. For
patients who are allergic to penicillin, administer erythromycin or a first-generation
cephalosporin.
Other options include clarithromycin for 10 days, azithromycin for 5 days, or a narrow-
spectrum (first-generation) cephalosporin for 10 days. To reduce inflammation, aspirin,
steroids, or non-steroidal medications may be given. Surgery may be necessary to repair
or replace the damaged valve.
Persons who have previously contracted rheumatic fever are often given continuous
(daily or monthly) antibiotic treatments, possibly for life, to prevent future attacks of
rheumatic fever and lower the risk of heart damage.