How should I manage a patient with rheumatic fever who presents with carditis?

Management of a patient with rheumatic fever presenting with carditis involves prompt initiation of anti-inflammatory treatment, eradication of the causative streptococcal infection, and careful cardiac monitoring to prevent progression to rheumatic heart disease.

Firstly, confirm the diagnosis of acute rheumatic fever with carditis based on clinical criteria and evidence of recent group A streptococcal infection. Treatment should include anti-inflammatory therapy, typically with aspirin or corticosteroids, to reduce inflammation of the heart tissues and alleviate symptoms of carditis ¹.

Secondly, eradicate the streptococcal infection using a full course of penicillin or an appropriate alternative antibiotic to prevent further immune-mediated damage ¹.

Thirdly, patients require close cardiac monitoring including echocardiography to assess the severity of valvular involvement and cardiac function, as carditis can lead to valvular damage and heart failure ¹. If heart failure develops, management should follow standard heart failure guidelines, including diuretics and other supportive measures ².

Long-term management includes secondary prophylaxis with regular intramuscular benzathine penicillin to prevent recurrent streptococcal infections and further rheumatic fever episodes, which can worsen cardiac damage ¹.

Recent literature emphasizes the importance of early recognition and aggressive management of carditis to reduce morbidity, and supports the use of corticosteroids in severe carditis cases, although aspirin remains the first-line anti-inflammatory agent in many protocols (Carapetis et al., 2007).