Therapy of Severe Rheumatic Carditis

Abstract

The data for 137 patients with severe rheumatic carditis and congestive heart failure were reviewed; 45 of these patients had pericarditis in addition to congestive heart failure. Of these 137 patients 53 were treated with steroids, 42 were given aspirin, and the remaining 42 patients were not given any antirheumatic drugs. The data show clearly that steroids had a definitely better therapeutic effect than aspirin. This conclusion is evident especially from the markedly lower death rate in the steroid-treated group and from the fact that not one of the patients developed a pericardial friction rub while on steroids. There are many variables which may have influenced these excellent results. Some of these variables could not be eliminated, especially because steroid treatment has been used only since 1949 whereas aspirin has been used for a longer period. Thus the possibility cannot be excluded that the results were influenced by the changing pattern of rheumatic fever during the last 2 decades or by the improved prevention of intercurrent strepto-coccal infections in recent years. However, it was demonstrated that the better results of steroid treatment were not due to the additional penicillin treatment, nor to the fact that there were slightly more first attacks of rheumatic fever in the steroid group. In spite of the fact that treatment in this series of cases could not be determined by random selection, the observations presented here strongly support our clinical impression that steroids in large dosage is the treatment of choice in severe rheumatic carditis with congestive heart failure or pericarditis.