Page 148 - Clinical Pearls in Cardiology

136 Clinical Pearls in Cardiology

pharyngeal or a cutaneous infection, but acute rheumatic
fever follows only a pharyngeal infection, and not a
cutaneous infection like pyoderma.
14. What do you know about the secondary prevention or
prophylaxis of acute rheumatic fever?
Patients with history of acute rheumatic fever are
susceptible to additional attacks of rheumatic fever if
further streptococcal infection occurs. So long-term
prophylaxis with penicillin should be given to these
patients.
In those with both carditis and residual heart disease,
prophylaxis should be given for at least 10 years or until
the age of 40 years (whichever is longer). In those with
carditis but without residual heart disease, prophylaxis
should be given for at least 10 years or until the age of
21 years (whichever is longer). In those without carditis,
duration of prophylaxis is at least 5 years or until the age
of 21 years (whichever is longer). Benzylpenicillin 1.2
million units im monthly (ideal choice if compliance
is a problem) or oral phenoxymethylpenicillin 250 mg
12 hourly may be used for secondary prevention or
prophylaxis. Sulfadiazine or erythromycin can be used in
patients who are allergic to pencillin. (Ref: Braunwald’s
heart disease, 9th edn, chapter 88).
15. What do you know about Takayasu arteritis?
Takayasu arteritis is an idiopathic large-vessel vasculitis
of young adults that affects the aorta and its major
branches. Women are affected about 10 times more
often than men. The median age at onset is 25 years.
Arterial stenoses occur three to four times more often
than aneurysms. Claudication (more common in upper
extremities) is the most common complaint. Asymmetry