When acute rheumatic fever involves the heart — presenting with carditis or heart failure — management extends well beyond the standard anti-inflammatory approach. Cardiac involvement can range from subclinical inflammation to acute valvular compromise requiring urgent intervention.
This protocol applies to patients with acute rheumatic fever in whom carditis or heart failure is present. Severe, acute carditis may require heart failure therapy. The degree of cardiac compromise — including valvular integrity — determines how the management pathway escalates.
In rare, life-threatening presentations with severe valvular compromise, surgical intervention may become necessary during the acute episode — the indications, surgical considerations, and full management algorithm are detailed in the complete protocol.
Treatment of heart failure may be required in severe, acute carditis.
Corticosteroids for severe carditis or pericarditis with effusion.
Valve surgery for life-threatening acute carditis (rare).
Valve leaflet or the rare occurrence of chordae tendineae rupture leads to severe regurgitation, necessitating emergency surgery.
Valve replacement, rather than repair, is usually performed during the acute episode because of the technical difficulties of repairing friable, inflamed valvular tissue.