{
  "schemaVersion": 2,
  "eyebrow": "Cardiology",
  "title": "Rheumatic Heart Disease",
  "summary": "Rheumatic heart disease requires parallel prevention of recurrent acute rheumatic fever, lesion-specific valve surveillance, anticoagulation when indicated, and early referral for catheter-based or surgical intervention before irreversible pulmonary vascular or ventricular consequences develop.",
  "seoDescription": "Point-of-care management of rheumatic heart disease: secondary penicillin prophylaxis, echocardiographic valve assessment, anticoagulation, and intervention.",
  "clinicalQuestion": "How should physicians prevent progression and manage valvular complications in patients with rheumatic heart disease?",
  "specialty": "Cardiology",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "rheumatic heart disease",
    "rheumatic mitral stenosis",
    "benzathine penicillin G",
    "secondary rheumatic fever prophylaxis",
    "percutaneous mitral balloon commissurotomy",
    "valvular heart disease"
  ],
  "keyTakeaways": [
    "Prescribe secondary rheumatic fever prophylaxis for every patient with rheumatic heart disease, including after valve replacement. [4][5]",
    "Benzathine penicillin G 1.2 million units intramuscularly every 4 weeks is a guideline-listed secondary prophylaxis regimen; oral penicillin V 250 mg twice daily is an alternative. [4]",
    "For rheumatic heart disease with documented valvular disease, continue prophylaxis for at least 10 years or until age 40 years, whichever is longer; lifelong prophylaxis is appropriate when group A streptococcal exposure risk remains high. [4]",
    "In asymptomatic severe rheumatic mitral stenosis, pulmonary artery systolic pressure greater than 50 mm Hg or new atrial fibrillation can justify referral for percutaneous mitral balloon commissurotomy when anatomy is favorable, mitral regurgitation is less than moderate, and left atrial thrombus is absent. [5]",
    "Use warfarin rather than assuming direct oral anticoagulant suitability in rheumatic mitral stenosis with atrial fibrillation; the labeled warfarin target INR for nonvalvular atrial fibrillation is 2.0 to 3.0, while valve-specific targets require individualized management. [2][3]"
  ],
  "sections": [
    {
      "id": "clinical-priorities",
      "eyebrow": "Initial decisions",
      "heading": "Separate recurrence prevention from valve-lesion management",
      "intro": "The first management decision is whether the patient needs prophylaxis, anticoagulation, valve intervention, or all three.",
      "paragraphs": [
        "Treat established rheumatic heart disease as an indication for secondary prevention of rheumatic fever, independent of whether the patient currently has pharyngitis symptoms or has already undergone valve replacement. Recurrent rheumatic fever worsens rheumatic valvular injury, and recurrent episodes may follow asymptomatic group A streptococcal infection despite treatment of symptomatic infections. [4][5]",
        "At each visit, define the dominant actionable problem with transthoracic Doppler echocardiography: valve lesion severity, mitral regurgitation grade, pulmonary pressures, left atrial thrombus status when intervention is contemplated, ventricular function, and whether findings support referral to a Comprehensive Valve Center. Serial echocardiographic assessment of valve and left ventricular function is a core component of long-term rheumatic heart disease management. [5][24]",
        "Escalate promptly when symptoms and noninvasive testing disagree about lesion severity. In symptomatic valvular heart disease, invasive cardiac catheterization for hemodynamic assessment is recommended when noninvasive testing is inconclusive or discordant with physical examination findings. [7]"
      ],
      "bullets": [
        "Document prior acute rheumatic fever, prior valve intervention, current secondary prophylaxis regimen, and the date of the last administered dose before changing therapy. [4][6]",
        "Obtain an ECG when assessing rhythm-related management because new atrial fibrillation changes candidacy for intervention in severe rheumatic mitral stenosis. [5]",
        "Refer patients with severe or symptomatic rheumatic valve disease for valve-center assessment rather than relying on pharmacotherapy to alter the natural history of advanced structural valve disease. [24]"
      ],
      "subsections": [],
      "table": {
        "caption": "Clinical decisions that should be addressed separately in rheumatic heart disease. [4][5][24]",
        "columns": [
          "Decision domain",
          "Actionable assessment",
          "Next management step"
        ],
        "rows": [
          [
            "Recurrent rheumatic fever",
            "Prior acute rheumatic fever or established rheumatic heart disease",
            "Initiate or maintain secondary antibiotic prophylaxis. [4][5]"
          ],
          [
            "Valve progression",
            "Serial Doppler echocardiography of valve and left ventricular function",
            "Use lesion severity and symptoms to determine timing of valve-center referral. [24]"
          ],
          [
            "Pulmonary hypertension in severe rheumatic MS",
            "Pulmonary artery systolic pressure >50 mm Hg",
            "Consider PMBC if anatomy is favorable, MR is <2+, and no LA thrombus is present. [5]"
          ],
          [
            "New atrial fibrillation in severe rheumatic MS",
            "New onset AF",
            "Consider PMBC under the same anatomic and thrombus restrictions; evaluate anticoagulation. [5]"
          ],
          [
            "Discordant severity assessment",
            "Symptoms with inconclusive or discordant noninvasive findings",
            "Perform invasive hemodynamic assessment by cardiac catheterization. [7]"
          ]
        ]
      }
    },
    {
      "id": "secondary-prophylaxis",
      "eyebrow": "Disease modification",
      "heading": "Use secondary antibiotic prophylaxis to prevent recurrent rheumatic fever",
      "intro": "Secondary prophylaxis prevents recurrent acute rheumatic fever rather than reversing established valve deformity.",
      "paragraphs": [
        "For patients with rheumatic heart disease, prescribe long-term antimicrobial prophylaxis rather than waiting to identify and treat each group A streptococcal episode. The ACC/AHA guideline lists benzathine penicillin G 1.2 million units intramuscularly every 4 weeks, penicillin V potassium 250 mg orally twice daily, sulfadiazine 1 g orally once daily, or a macrolide/azalide when the patient is allergic to both penicillin and sulfadiazine. [4]",
        "For documented rheumatic valvular heart disease, continue prophylaxis for at least 10 years or through age 40 years, whichever is longer. Consider lifelong prophylaxis when the patient remains at high risk of group A streptococcal exposure; prophylaxis remains required after valve replacement. [4]",
        "Intramuscular benzathine penicillin G given every 3 to 4 weeks is described as the first-line secondary prophylaxis strategy. However, in severe rheumatic heart disease, concern that an injection-related event may precipitate cardiac compromise supports strong consideration of oral antibiotics when the risk-benefit assessment favors avoiding intramuscular administration. [6]"
      ],
      "bullets": [
        "ARF without carditis: continue prophylaxis until age 21 years or for 5 years after the last episode, whichever is longer. [6]",
        "ARF with carditis but no residual valvular disease: continue until age 21 years or for 10 years after the last episode, whichever is longer. [6]",
        "ARF with carditis and residual valvular disease: continue until age 40 years or for 10 years after the last episode, whichever is longer; some patients require lifelong prophylaxis. [6]",
        "Do not discontinue secondary prophylaxis solely because the patient has received a prosthetic valve. [4]"
      ],
      "subsections": [],
      "table": {
        "caption": "Secondary prophylaxis regimens and duration rules for rheumatic fever and rheumatic heart disease. [4][6]",
        "columns": [
          "Clinical setting",
          "Regimen",
          "Duration"
        ],
        "rows": [
          [
            "Established rheumatic heart disease",
            "Benzathine penicillin G 1.2 million units IM every 4 weeks; alternatives include penicillin V 250 mg orally twice daily or sulfadiazine 1 g orally once daily. [4]",
            "At least 10 years or until age 40 years, whichever is longer; consider lifelong prophylaxis with ongoing high exposure risk. [4]"
          ],
          [
            "ARF without carditis",
            "Secondary prophylaxis with IM benzathine penicillin G every 3-4 weeks or daily oral penicillin V. [6]",
            "Until age 21 years or 5 years after the last ARF episode, whichever is longer. [6]"
          ],
          [
            "ARF with carditis, no residual valve damage",
            "Secondary prophylaxis with IM benzathine penicillin G every 3-4 weeks or daily oral penicillin V. [6]",
            "Until age 21 years or 10 years after the last ARF episode, whichever is longer. [6]"
          ],
          [
            "ARF with carditis and residual valve damage",
            "Secondary prophylaxis with IM benzathine penicillin G every 3-4 weeks or daily oral penicillin V. [6]",
            "Until age 40 years or 10 years after the last ARF episode, whichever is longer; lifelong treatment may be needed. [6]"
          ]
        ]
      }
    },
    {
      "id": "mitral-stenosis-intervention",
      "eyebrow": "Valve intervention",
      "heading": "Identify severe rheumatic mitral stenosis appropriate for balloon commissurotomy",
      "intro": "Severe rheumatic mitral stenosis has a specific anatomic and clinical pathway for catheter-based intervention.",
      "paragraphs": [
        "Classify rheumatic mitral stenosis as severe when mitral valve area is 1.5 cm² or less. In an asymptomatic patient, elevated pulmonary artery systolic pressure above 50 mm Hg supports intervention rather than observation when valve morphology is favorable, mitral regurgitation is less than 2+, and no left atrial thrombus is present. [5]",
        "Refer such patients to a Comprehensive Valve Center for percutaneous mitral balloon commissurotomy (PMBC). The same anatomic restrictions apply when new-onset atrial fibrillation is the trigger for considering PMBC in an otherwise asymptomatic patient with severe rheumatic mitral stenosis. [5]",
        "Before PMBC, resolve the key exclusion branch: left atrial thrombus, at least moderate mitral regurgitation, or unfavorable valve morphology should redirect discussion away from routine balloon commissurotomy toward individualized structural and surgical evaluation. The guideline recommendations supporting PMBC explicitly require favorable anatomy, less than 2+ mitral regurgitation, and absence of left atrial thrombus. [5]"
      ],
      "bullets": [
        "Mitral valve area ≤1.5 cm² defines severe rheumatic mitral stenosis in the cited ACC/AHA intervention recommendations. [5]",
        "Pulmonary artery systolic pressure >50 mm Hg is the threshold supporting PMBC consideration in asymptomatic severe rheumatic mitral stenosis. [5]",
        "New-onset atrial fibrillation is a separate trigger for PMBC consideration in asymptomatic severe rheumatic mitral stenosis. [5]",
        "Use a Comprehensive Valve Center for PMBC evaluation and performance. [5]"
      ],
      "subsections": [],
      "table": {
        "caption": "ACC/AHA triggers for PMBC consideration in asymptomatic severe rheumatic mitral stenosis. [5]",
        "columns": [
          "Trigger",
          "Required conditions",
          "Recommended action"
        ],
        "rows": [
          [
            "Pulmonary artery systolic pressure >50 mm Hg",
            "Mitral valve area ≤1.5 cm²; favorable morphology; MR <2+; no LA thrombus. [5]",
            "PMBC is reasonable at a Comprehensive Valve Center. [5]"
          ],
          [
            "New-onset atrial fibrillation",
            "Mitral valve area ≤1.5 cm²; favorable morphology; MR <2+; no LA thrombus. [5]",
            "PMBC may be considered at a Comprehensive Valve Center. [5]"
          ]
        ]
      }
    },
    {
      "id": "anticoagulation-and-procedural-follow-up",
      "eyebrow": "Thromboembolic management",
      "heading": "Manage anticoagulation and follow-up as valve-specific decisions",
      "intro": "Atrial fibrillation and prosthetic valves add anticoagulation requirements that are distinct from antibiotic prophylaxis.",
      "paragraphs": [
        "For warfarin, use indication-specific INR targets and frequent INR monitoring. The FDA label directs daily INR determinations during initiation until the INR is stable in the therapeutic range, followed by INR testing every 1 to 4 weeks; the labeled target for nonvalvular atrial fibrillation is INR 2.5, with a therapeutic range of 2.0 to 3.0. [2][3]",
        "Do not extrapolate the nonvalvular atrial fibrillation target automatically to every rheumatic valve scenario. The label notes that warfarin has not been fully evaluated in valvular disease associated with atrial fibrillation and mitral stenosis, although a moderate-intensity INR range of 2.0 to 3.0 may be used; management for prosthetic valves may require a higher INR target and addition of aspirin depending on valve type, position, and patient factors. [1][3]",
        "Warfarin is contraindicated in pregnancy except for women with mechanical heart valves, and it crosses the placenta with risk of fetal hemorrhage and reported congenital malformations. Patients with rheumatic heart disease who may become pregnant therefore need preconception cardiology and obstetric assessment before anticoagulant selection or valve intervention planning. [1][2][22]"
      ],
      "bullets": [
        "If genotype is not used for dose selection, the labeled initial warfarin dose is usually 2 to 5 mg once daily; typical maintenance doses are 2 to 10 mg once daily, adjusted to INR response and indication. [3]",
        "Review valve type and position before selecting an INR target or deciding whether aspirin is added for a prosthetic valve. [1]",
        "Maintain oral health and assess eligibility for infective endocarditis prophylaxis separately from rheumatic fever prophylaxis. For high-risk valvular patients, antibiotic prophylaxis is not recommended for TEE, EGD, colonoscopy, or cystoscopy without active infection. [5][24]"
      ],
      "subsections": [],
      "table": {
        "caption": "Warfarin monitoring and special populations relevant to rheumatic heart disease. [1][2][3]",
        "columns": [
          "Situation",
          "Action",
          "Important limitation"
        ],
        "rows": [
          [
            "Warfarin initiation",
            "Check INR daily until stable in the therapeutic range. [2]",
            "Initial dose is individualized; usual labeled starting dose without genotype is 2-5 mg daily. [3]"
          ],
          [
            "Stable warfarin therapy",
            "Check INR every 1-4 weeks. [2]",
            "Adjust target to the indication and valve characteristics. [1][3]"
          ],
          [
            "Nonvalvular AF",
            "Target INR 2.5, range 2.0-3.0. [2][3]",
            "This target should not be assumed sufficient for every prosthetic-valve setting. [1]"
          ],
          [
            "Pregnancy",
            "Obtain specialized preconception and pregnancy planning. [22]",
            "Warfarin is contraindicated in pregnancy except in women with mechanical heart valves. [2]"
          ]
        ]
      }
    },
    {
      "id": "longitudinal-care",
      "eyebrow": "Long-term management",
      "heading": "Build follow-up around adherence, echocardiography, and timely referral",
      "intro": "Long-term outcomes depend on preventing recurrences and identifying structural progression before advanced complications limit treatment options.",
      "paragraphs": [
        "Use a structured recall system for injections or oral prophylaxis, anticoagulation monitoring when applicable, clinical review, and serial echocardiography. Rheumatic heart disease care frameworks emphasize patient registers to coordinate cardiac monitoring, follow-up appointments, and surgical waiting lists. [24]",
        "At each cardiology review, reassess symptoms, rhythm, anticoagulation status, valve severity, ventricular function, and pulmonary pressures. Refer for catheter-based or surgical intervention when disease is severe or symptomatic; pharmacologic treatment of severe rheumatic heart disease has limited evidence for changing outcomes compared with timely structural intervention. [24]",
        "For patients of reproductive potential, integrate preconception assessment rather than deferring risk review until pregnancy. Maternal cardiovascular disease is a leading contributor to pregnancy-related mortality in the United States, and rheumatic valve disease management may require coordinated antepartum and postpartum planning. [22]"
      ],
      "bullets": [
        "Track missed benzathine penicillin G injections or oral prophylaxis interruptions because secondary prevention depends on sustained delivery. [6][17]",
        "Use exercise testing selectively in asymptomatic severe valvular heart disease to confirm symptom status, assess hemodynamic response, or refine prognosis. [7]",
        "When symptoms are present but echocardiographic or examination findings are discordant, use invasive hemodynamic assessment rather than delaying definitive evaluation. [7]"
      ],
      "subsections": [],
      "table": {
        "caption": "Longitudinal follow-up actions for patients with rheumatic heart disease. [7][22][24]",
        "columns": [
          "Follow-up domain",
          "Assessment",
          "Action if abnormal"
        ],
        "rows": [
          [
            "Secondary prevention",
            "Prophylaxis regimen, dose interval, and missed doses. [4][6]",
            "Restore scheduled prophylaxis and reassess regimen tolerability. [4][6]"
          ],
          [
            "Structural valve disease",
            "Serial echocardiographic valve and LV assessment. [24]",
            "Refer for valve-center assessment when severe or symptomatic disease is identified. [24]"
          ],
          [
            "Symptom clarification",
            "Exercise testing in selected asymptomatic severe VHD. [7]",
            "Use results to establish symptom status, hemodynamic response, or prognosis. [7]"
          ],
          [
            "Pregnancy planning",
            "Prepregnancy cardiovascular assessment. [22]",
            "Coordinate cardiology and obstetric care before conception. [22]"
          ]
        ]
      }
    }
  ],
  "faq": [],
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  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
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      "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=bf21781b-d4d5-456d-a5bc-d48bd2da61ce&type=display",
      "authors": "dailymed.nlm.nih.gov",
      "host": "dailymed.nlm.nih.gov",
      "snippet": "Adjust the warfarin dose to maintain a target INR of 2.5 (INR range, 2 to 3) for all treatment durations. The duration of treatment is based on the indication as follows:\n\nAtrial Fibrillation\n\nIn patients with non-valvular AF, anticoagulate with warfarin to target INR of 2.5 (range, 2 to 3).\n\nMechan",
      "score": 0.16775002
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    {
      "number": 4,
      "title": "2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines",
      "detail": "www.jacc.org",
      "url": "https://www.jacc.org/doi/10.1016/j.jacc.2020.11.018",
      "authors": "www.jacc.org",
      "host": "www.jacc.org",
      "snippet": "Table 6 Secondary Prevention of Rheumatic Fever\n\n| Antibiotics for Prevention | Dosage∗ |\n --- |\n| Penicillin G benzathine | 1.2 million U intramuscularly every 4 wk† |\n| Penicillin V potassium | 250 mg orally twice daily |\n| Sulfadiazine | 1 g orally once daily |\n| Macrolide or azalide antibiotic (",
      "score": 0.8482825
    },
    {
      "number": 5,
      "title": "2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | JACC",
      "detail": "www.jacc.org",
      "url": "https://www.jacc.org/doi/10.1016/j.jacc.2020.11.035",
      "authors": "www.jacc.org",
      "host": "www.jacc.org",
      "snippet": "Table 2 Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care (Updated May 2019)∗\n\nImage 2\n\n## 2 General Principles\n\n### 2.4 Basic Principles of Medical Therapy\n\n#### 2.4.1 Secondary Prevention of Rheumatic Fev",
      "score": 0.7420672
    },
    {
      "number": 6,
      "title": "Rheumatic Heart Disease: JACC Focus Seminar 2/4",
      "detail": "www.jacc.org",
      "url": "https://www.jacc.org/doi/10.1016/j.jacc.2022.09.050",
      "authors": "www.jacc.org",
      "host": "www.jacc.org",
      "snippet": "| Prevention of recurrences | Secondary penicillin prophylaxis | Secondary prophylaxis prevents recurrences of ARF and progression of heart valve damage | 3-4 weekly intramuscular BPG or daily oral penicillin V (2009 AHA guidelines): ARF without carditis: until age 21 years or for 5 years after last",
      "score": 0.72559077
    },
    {
      "number": 7,
      "title": "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines",
      "detail": "www.jacc.org",
      "url": "https://www.jacc.org/doi/10.1016/j.jacc.2014.02.537",
      "authors": "www.jacc.org",
      "host": "www.jacc.org",
      "snippet": "4.\n\nCardiac catheterization for hemodynamic assessment is recommended in symptomatic patients when noninvasive tests are inconclusive or when there is a discrepancy between the findings on noninvasive testing and physical examination regarding severity of the valve lesion. _(Level of Evidence: C)_\n\n",
      "score": 0.6649108
    },
    {
      "number": 8,
      "title": "Revision of the Jones Criteria for the Diagnosis of Acute ...",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/pdf/10.1161/cir.0000000000000205",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "by MH Gewitz · 2015 · Cited by 981 — Jones criteria used to diagnose acute rheumatic fever. Doppler echocardiography in the diagnosis of carditis as a major manifestation of acute",
      "score": 0.7931224
    },
    {
      "number": 9,
      "title": "Preventive Interventions to Reduce the Burden of ...",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/JAHA.123.032442",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "by PP Shimanda · 2024 · Cited by 29 — Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography",
      "score": 0.7036111
    },
    {
      "number": 10,
      "title": "Proceedings of the Jones Criteria Workshop | Circulation",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/01.cir.0000037745.65929.fa",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "by P Ferrieri · 2002 · Cited by 203 — Extensive discussion focused on the diagnostic potential of Doppler echocardiography and its possible role in the diagnosis of acute rheumatic carditis.",
      "score": 0.68191797
    },
    {
      "number": 11,
      "title": "Rheumatic and Nonrheumatic Valvular Heart Disease",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/circulationaha.105.539775",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "Doppler echocardiography was the sole means for the diagnosis of carditis 5 and increased the diagnosis of carditis based on the Jones criteria",
      "score": 0.6490677
    },
    {
      "number": 12,
      "title": "Screening for rheumatic heart disease: current approaches and controversies | Nature Reviews Cardiology",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/nrcardio/journal/v10/n1/pdf/nrcardio.2012.157.pdf%3FWT.ec_id%3DNRCARDIO-201301",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "Title: Screening for rheumatic heart disease: current approaches and controversies | Nature Reviews Cardiology\n# Screening for rheumatic heart disease: current approaches and controversies. * Rheumatic heart disease (RHD) is preventable, yet continues to be a leading cause of cardiac disease in chil",
      "score": 0.75049835
    },
    {
      "number": 13,
      "title": "Acute rheumatic fever and rheumatic heart disease | Nature Reviews Disease Primers",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/s41572-026-00685-y?fromPaywallRec=true",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "Title: Acute rheumatic fever and rheumatic heart disease | Nature Reviews Disease Primers\nYou are using a browser version with limited support for CSS. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. # Acute rheumatic fever and rheumatic heart ",
      "score": 0.7286136
    },
    {
      "number": 14,
      "title": "Guidelines for the secondary prevention of rheumatic heart... : International Journal of Pediatrics and Adolescent Medicine",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/ijpam/fulltext/2017/04010/guidelines_for_the_secondary_prevention_of.8.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "Title: Guidelines for the secondary prevention of rheumatic heart... : International Journal of Pediatrics and Adolescent Medicine\n# Guidelines for the secondary prevention of rheumatic heart disease Endorsed by Saudi Pediatric Infectious Diseases Society (SPIDS). Rheumatic fever and rheumatic heart",
      "score": 0.8302782
    },
    {
      "number": 15,
      "title": "2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/IJPH/00003017-201706200-00012.fulltext",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines | Circulation. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Gu",
      "score": 0.66308063
    },
    {
      "number": 16,
      "title": "Predictors of rheumatic fever in sore throat patients",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/trstmh/article/116/4/286/6390725",
      "authors": "academic.oup.com",
      "host": "academic.oup.com",
      "snippet": "by E Kulik · 2022 · Cited by 12 — Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American",
      "score": 0.68191797
    },
    {
      "number": 17,
      "title": "Adherence to secondary prevention of rheumatic fever and ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13250",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "by J Liaw · 2022 · Cited by 13 — Secondary prophylaxis every 21–28 days with intramuscular benzathine penicillin G (BPG) is effective for preventing group A streptococcal",
      "score": 0.26794702
    },
    {
      "number": 18,
      "title": "Utility of lidocaine in reducing pain of intramuscular...",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/aopc/fulltext/2024/17060/utility_of_lidocaine_in_reducing_pain_of.5.aspx?context=latestarticles",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "by NPVK Yantie · 2024 · Cited by 1 — The current recommended secondary prevention of rheumatic fever (RF)/rheumatic heart disease (RHD) includes every 21–28 days injection of benzathine penicillin",
      "score": 0.26288489
    },
    {
      "number": 19,
      "title": "Delayed Diagnosis of Acute Rheumatic Fever in a Patient ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1155/2018/9467131",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "All patients who have had acute rheumatic fever will require secondary prophylaxis with intramuscular penicillin G benzathine every 4 weeks for",
      "score": 0.25753438
    },
    {
      "number": 20,
      "title": "Acute rheumatic fever: Adherence to secondary ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1111/j.1440-1584.2007.00896.x",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "We aimed to assess the rate of adherence with penicillin prophylaxis and follow-up guidelines in patients with previous ARF and the effect of",
      "score": 0.1947048
    },
    {
      "number": 21,
      "title": "Rheumatic fever recurrence prevention: A nurse‐led programme ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2010.01942.x",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "Aims: To evaluate safety and effectiveness of 28-day long-acting penicillin to prevent recurrences of acute rheumatic fever (ARF).",
      "score": 0.18528324
    },
    {
      "number": 22,
      "title": "ACOG Practice Bulletin No. 212: Pregnancy and... : Obstetrics & Gynecology",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/greenjournal/fulltext/10.1097/aog.0000000000003243~acog-practice-bulletin-no-212-pregnancy-and-heart-disease",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "present a comprehensive interpregnancy care plan for women with heart disease. [...] to prepregnancy cardiovascular disease assessment, missed opportunities to identify cardiovascular disease risk factors during prenatal care, gaps in high-risk intrapartum care, and delays in recognition of cardiova",
      "score": 0.14411299
    },
    {
      "number": 23,
      "title": "Acute Rheumatic Fever and Rheumatic Heart Disease | ScienceDirect",
      "detail": "sciencedirect.com",
      "url": "https://sciencedirect.com/book/9780323639828/acute-rheumatic-fever-and-rheumatic-heart-disease",
      "authors": "sciencedirect.com",
      "host": "sciencedirect.com",
      "snippet": "Title: Acute Rheumatic Fever and Rheumatic Heart Disease | ScienceDirect\n# Acute Rheumatic Fever and Rheumatic Heart Disease. **Edited by:** Scott Dougherty, Jonathan Carapetis, ... # Acute Rheumatic Fever and Rheumatic Heart Disease. * Divided into four distinct sections for ease of navigation: Acu",
      "score": 0.72395444
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    {
      "number": 24,
      "title": "Medical Management of Rheumatic Heart Disease - ScienceDirect",
      "detail": "sciencedirect.com",
      "url": "https://sciencedirect.com/science/article/pii/B9780323639828000064",
      "authors": "sciencedirect.com",
      "host": "sciencedirect.com",
      "snippet": "## Acute Rheumatic Fever and Rheumatic Heart Disease. # Chapter 6- Medical Management of Rheumatic Heart Disease. Best practices guidelines for the long-term management of rheumatic heart disease (RHD) include secondary prevention with penicillin prophylaxis, clinical reviews by a specialist experie",
      "score": 0.7099254
    }
  ],
  "publishedAt": "2026-08-24T17:16:30.610853+00:00",
  "updatedAt": "2026-08-24T17:16:30.610853+00:00",
  "readingMinutes": 6,
  "slug": "rheumatic-heart-disease"
}