Clinical Evaluation and Diagnosis of Rheumatic Heart Disease

Horton, Ari; Gentles, T.; Reményi, Bo

doi:10.1016/b978-0-323-63982-8.00005-2

Cited by 3 publications

(1 citation statement)

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“…Additionally, many of the reported deaths have occurred in patients with severe mitral regurgitation in the setting of symptomatic heart failure and left ventricular dysfunction. 18 Thus, we believe that while well‐compensated severe mitral regurgitation does not have increased risk and is not a contraindication to BPG, symptomatic patients with severe mitral regurgitation, in particular those who are cachectic and have decreased left ventricular systolic function, are at elevated risk. Because patients with severe MR often straddle (or move back and forth between) low‐ and elevated‐risk categories, this group requires frequent individualized assessment of risk, with adjustment regarding oral versus injectable penicillin for patients as needed.…”

Section: Risk Identificationmentioning

confidence: 94%

Penicillin Reactions in Patients With Severe Rheumatic Heart Disease: A Presidential Advisory From the American Heart Association

Sanyahumbi¹,

Ali²,

Benjamin³

et al. 2022

JAHA

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Secondary antibiotic prophylaxis with regular intramuscular benzathine penicillin G (BPG) is the cornerstone of rheumatic heart disease management. However, there is a growing body of evidence that patients with rheumatic heart disease who have severe valvular heart disease with or without reduced ventricular function may be dying from cardiovascular compromise following BPG injections. This advisory responds to these concerns and is intended to: (1) raise awareness, (2) provide risk stratification, and (3) provide strategies for risk reduction. Based on available evidence and expert opinion, we have divided patients into low‐ and elevated‐risk groups, based on symptoms and the severity of underlying heart disease. Patients with elevated risk include those with severe mitral stenosis, aortic stenosis, and aortic insuffiency; those with decreased left ventricular systolic dysfunction; and those with no symptoms. For these patients, we believe the risk of adverse reaction to BPG, specifically cardiovascular compromise, may outweigh its theoretical benefit. For patients with elevated risk, we newly advise that oral prophylaxis should be strongly considered. In addition, we advocate for a multifaceted strategy for vasovagal risk reduction in all patients with rheumatic heart disease receiving BPG. As current guidelines recommend, all low‐risk patients without a history of penicillin allergy or anaphylaxis should continue to be prescribed BPG for secondary antibiotic prophylaxis. We publish this advisory in the hopes of saving lives and avoiding events that can have devastating effects on patient and clinician confidence in BPG.

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Section: Risk Identificationmentioning

confidence: 94%