Treatment of Rheumatic Heart Disease in Aortic Regurgitation
Rheumatic heart disease in a patient with aortic regurgitation presents specific management
considerations, particularly when left ventricular dysfunction or heart failure is present.
Clinical scenario
This protocol addresses rheumatic heart disease in the setting of
aortic regurgitation (AR) — a valvular lesion that can lead to
progressive left ventricular dysfunction and heart failure, requiring targeted medical management.
Treatment approach
Medical therapy in this setting is directed primarily at symptom relief and management
of underlying left ventricular dysfunction and heart failure. Certain classes of agents —
including those acting on the renin-angiotensin system and agents targeting cardiac workload —
have demonstrated benefit in patients with AR in this context.
The complete regimen, sequencing, and selection criteria are in the full protocol.
References
As yet, no medical therapy has been shown to slow the progression of AR, and so treatment is predominantly targeted at symptom relief and treatment of underlying left ventricular dysfunction and heart failure.
Treatment with angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and β-blockers has been shown to be beneficial in large population cohort studies in patients with AR, particularly those with left ventricular dysfunction.
DOI: 10.1161/CIR.0000000000000921
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