If Getting My Blood Pressure Checked Is Wrong, I Don't Want To Be Right!!

[+ Gar1eth]

I've been on blood pressure medication for years-Diovan 160/hydrochlorothiazide 12.5 in case you are interested. My blood pressure does ok on it. It's not super low-but it's not super high either. My last check was 146/84.

 

So to get my blood pressure checked a few times a month I go to one of the local fire stations. (I have no faith in the nurse at my healthcare office. Her technique is atrocious!!). Occasionally the fire person checking me out, I mean checking my BP out;), is a hunky, in shape guy.

 

Seeing a hunky fireguy adds a bit of zing to my day-a small guilty pleasure as it were.

 

It's only too bad life isn't like a porn shoot because we'd know how these visits would end if they were.

 

Gman

[+ Funguy]

Hmmmm. Is it a good thing to have that BP checked by a hunk? Well, I guess you could subtract a few points on the systolic (upper number) for a truer reading!

[whipped guy]

LOL! I was going to tell you to buy a unit and test it yourself. However, the local fire station and the hunky guy is a much better alternative! Way to go!!!!!

 

[+ Phactor]

Uh, yeah, that BP might not be completely accurate if you're feeling some zing. Does he also check the heart rate? You may be able to drop a few points off of that systolic (top) number.

 

For our healthcare folks in the community, check out this case study from about 15 years ago in JRSM:

 

Resting blood pressure was 93/50 mmHg, heart rate 68/min. He then had sexual stimulation leading to orgasm. During stimulation the blood pressure rose rapidly and at the point of ejaculation it was 325/210 mmHg, with a heart rate 55/min. Over the next seven minutes the blood pressure fell to 155/90 mmHg, with little change in heart rate

[gallahadesquire]

JRSM = Journal of Reproduction and Sexual Medicine, or so I thought. Journal of the Royal Society of Medicine is more like it.

[+ Gar1eth]

Uh, yeah, that BP might not be completely accurate if you're feeling some zing. Does he also check the heart rate? You may be able to drop a few points off of that systolic (top) number.

 

For our healthcare folks in the community, check out this case study from about 15 years ago in JRSM:

 

Resting blood pressure was 93/50 mmHg, heart rate 68/min. He then had sexual stimulation leading to orgasm. During stimulation the blood pressure rose rapidly and at the point of ejaculation it was 325/210 mmHg, with a heart rate 55/min. Over the next seven minutes the blood pressure fell to 155/90 mmHg, with little change in heart rate

 

The fire station is across the street from a Safeway. I went there after I had seen the reasonably hunky fireguy to pick up some prescriptions at their pharmacy (one of them was generic sildenafil;)-by the way I'm going to start a thread about the cheap Viagra a little later today. Be on the look-out for it!!). I used their automatic health checker machine. It measured my blood pressure at 133 over 80 something with a heart rate of 70. I don't know how much to trust that machine for a BP as 5 minutes before my BP was 13 higher. But I figure my pulse was easier to measure. So you'll be glad to know, I wasn't tachycardic from the hunky 35 year old fireguy.

 

@FreshFluff, @tyro, and @quoththeraven maybe this could be a way to meet a hunky in shape guy if y'all are in the market.

 

Gman

[whipped guy]

It's normal for blood pressure to vary. The heart and circulatory system are a dynamic system. The numbers are never exactly the same. As long as there are no overly large swings in a relatively short period of time it's all probably normal. One can get overly analytical with such things even if it is something to be aware of. Now if you are 133/80 and then 185/85 over the same day it could be a danger sign.

[+ Funguy]

Like the new avatar, WG! I'm tingling already!

[+ Funguy]

It's normal for blood pressure to vary. The heart and circulatory system are a dynamic system. The numbers are never exactly the same. As long as there are no overly large swings in a relatively short period of time it's all probably normal. One can get overly analytical with such things even if it is something to be aware of. Now if you are 133/80 and then 185/85 over the same day it could be a danger sign.

 

I'm due for an ECHO Stress test ... bad numbers and bad family history: father - MI; mother - MI; 3/4 grandparents - MI's; brother - MI; several cousins - MI's. Physical condition (incl BP) - weight - diet - exercise history has nothing to do with it. That gene is hiding in there!

[+ Gar1eth]

I'm due for an ECHO Stress test ... bad numbers and bad family history: father - MI; mother - MI; 3/4 grandparents - MI's; brother - MI; several cousins - MI's. Physical condition (incl BP) - weight - diet - exercise history has nothing to do with it. That gene is hiding in there!

 

I had one of those years ago. The details are a bit fuzzy as this was 19 years ago. But I woke up in the middle of the night with this incredible chest pain. I realized it could be a heart attack. So being the smart, intelligent 36 year old I was, I drove myself to the ED:confused:.

 

I can't quite remember what happened after that, but the pain eventually went away. They decided it wasn't a heart attack. I went home. A few days later I was talking to an old friend from my university who was now a cardiologist. He said you should have a stress Echo. So I had him do it. He didn't see any problem with my coronary arteries. But he diagnosed me with moderate mitral regurgitation. He said it was moderate because of how far the 'jet' of blood through the leaky valve traveled backward-or something like that.

 

Well over the years I've had my mitral valve rechecked by the doctors. Most of them, even cardiologists, can't hear the leak. I've also had multiple ECHOS over the years. On the last Echo three years ago they couldn't even find any leakiness in my valve. I think my friend having seen the moderate leak had to do with me having exercised and really stressing my heart. In normal

circumstances apparently it doesn't leak very much. I had been worried whether it ran in families as my Dad's mitral valve was totally kaput. They tried to repair it. It didn't work. A year or so later they put in a titanium valve.

 

[uSER=9945]@funguy[/uSER] I'm hoping the results come out perfectly fine!! Is there a reason that they aren't doing a nuclear stress test? My limited understanding was that they were more sensitive.

 

Gman

 

PS I had the pain 2 more times over the next year. On the third episode the pain was so bad, I almost couldn't breathe. This time the ED said I had an elevation on my EKG. They put me overnight on a nitro drip (such a headache) in the Cardiac Intermediate Care Unit for monitoring. Come morning they've decided it's not a heart attack. So they do more investigating. An ultrasound shows that I have a few gallstones. They decide the pain is from my gallbladder. After that the next time I had the pain (it started occurring more frequently after that), I realized that the pain actually did start just below my ribs on the right and traveled up to the center of my chest.

 

The funny thing was that for months beforehand occurring multiple days a week in the mornings I had been having what I thought were severe hunger pangs. The pangs were weird because I have not eaten breakfast regularly since I was in junior high. Most mornings my first food was lunch. I couldn't understand why my stomach was all of a sudden reacting so badly to not eating in the morning when that had been normal for years.

 

It turns out the pangs weren't due to hunger. They were due to my gallbladder.

 

I tolerated the increasingly frequent gallbladder attacks for about two more months, and then finally had my gallbladder removed.

 

Gman

[+ Funguy]

I had one of those years ago. The details are a bit fuzzy as this was 19 years ago. But I woke up in the middle of the night with this incredible chest pain. I realized it could be a heart attack. So being the smart, intelligent 36 year old I was, I drove myself to the ED:confused:.

 

I can't quite remember what happened after that, but the pain eventually went away. They decided it wasn't a heart attack. I went home. A few days later I was talking to an old friend from my university who was now a cardiologist. He said you should have a stress Echo. So I had him do it. He didn't see any problem with my coronary arteries. But he diagnosed me with moderate mitral regurgitation. He said it was moderate because of how far the 'jet' of blood through the leaky valve traveled backward-or something like that.

 

Well over the years I've had my mitral valve rechecked by the doctors. Most of them, even cardiologists, can't hear the leak. I've also had multiple ECHOS over the years. On the last Echo three years ago they couldn't even find any leakiness in my valve. I think my friend having seen the moderate leak had to do with me having exercised and really stressing my heart. In normal

circumstances apparently it doesn't leak very much. I had been worried whether it ran in families as my Dad's mitral valve was totally kaput. They tried to repair it. It didn't work. A year or so later they put in a titanium valve.

 

[uSER=9945]@funguy[/uSER] I'm hoping the results come out perfectly fine!! Is there a reason that they aren't doing a nuclear stress test? My limited understanding was that they were more sensitive.

 

Gman

 

Totally asymptomatic and this is being done because of family history/lab values/borderline BP. As an aside, I can tell you that I stress myself (in a fun way) a few times a month and have never had a problem!

[Irtwo]

I didn't realize that fire stations gave blood pressure checks, is that something most do?

[+ Gar1eth]

I didn't realize that fire stations gave blood pressure checks, is that something most do?

 

I'm sure it depends on where you live. I think most places I've lived over the last 10 years they've done it.

 

Gman

[+ Phactor]

I didn't realize that fire stations gave blood pressure checks, is that something most do?

 

As Gman said, it depends on where you live, but odds are they will. So many improvements have been made in the area of fire prevention that most fire departments rarely fight fires any more. In fact, one local department by me requires all of its non-officers to be paramedic-trained and keep advanced life support equipment on all of its rigs. Last year, their service call breakdown like this:

 

77% Medical response

20% Rescue response

3% Fire response

[whipped guy]

I had one of those years ago. The details are a bit fuzzy as this was 19 years ago. But I woke up in the middle of the night with this incredible chest pain. I realized it could be a heart attack. So being the smart, intelligent 36 year old I was, I drove myself to the ED:confused:.

 

I can't quite remember what happened after that, but the pain eventually went away. They decided it wasn't a heart attack. I went home. A few days later I was talking to an old friend from my university who was now a cardiologist. He said you should have a stress Echo. So I had him do it. He didn't see any problem with my coronary arteries. But he diagnosed me with moderate mitral regurgitation. He said it was moderate because of how far the 'jet' of blood through the leaky valve traveled backward-or something like that.

 

Well over the years I've had my mitral valve rechecked by the doctors. Most of them, even cardiologists, can't hear the leak. I've also had multiple ECHOS over the years. On the last Echo three years ago they couldn't even find any leakiness in my valve. I think my friend having seen the moderate leak had to do with me having exercised and really stressing my heart. In normal

circumstances apparently it doesn't leak very much. I had been worried whether it ran in families as my Dad's mitral valve was totally kaput. They tried to repair it. It didn't work. A year or so later they put in a titanium valve.

 

[uSER=9945]@funguy[/uSER] I'm hoping the results come out perfectly fine!! Is there a reason that they aren't doing a nuclear stress test? My limited understanding was that they were more sensitive.

 

Gman

 

PS I had the pain 2 more times over the next year. On the third episode the pain was so bad, I almost couldn't breathe. This time the ED said I had an elevation on my EKG. They put me overnight on a nitro drip (such a headache) in the Cardiac Intermediate Care Unit for monitoring. Come morning they've decided it's not a heart attack. So they do more investigating. An ultrasound shows that I have a few gallstones. They decide the pain is from my gallbladder. After that the next time I had the pain (it started occurring more frequently after that), I realized that the pain actually did start just below my ribs on the right and traveled up to the center of my chest.

 

The funny thing was that for months beforehand occurring multiple days a week in the mornings I had been having what I thought were severe hunger pangs. The pangs were weird because I have not eaten breakfast regularly since I was in junior high. Most mornings my first food was lunch. I couldn't understand why my stomach was all of a sudden reacting so badly to not eating in the morning when that had been normal for years.

 

It turns out the pangs weren't due to hunger. They were due to my gallbladder.

 

I tolerated the increasingly frequent gallbladder attacks for about two more months, and then finally had my gallbladder removed.

Gman

@Gar1eth 's posting above about chest pain reminded me of an incident from years ago when the medical profession was convinced that unless you were on antibiotics for a mitral valve issue you were going to die a horrible death if you went to the dentist. Talk about the abuse and overuse of antibiotics!!!!

 

In any event, I had a patient who was seen by an endodontist for a root canal. When he left the office and started walking back to work he suddenly felt a pain over the left side of his chest. Like Gman he went to the ER of the local hospital. They asked him what he had done prior to the pain. He said that he was at the dentist. They freaked out, admitted him, and gave him massive doses of antibiotics and told him that he had bacterial endocarditis.

 

A short time later someone decided to take a chest X-Ray and he actually had a fractured rib!!!! This boggles the mind, but it is a true story!

 

Incidentally, I stopped going to a local MD when he told me that he heard a mitral valve issue and wanted me to have an Echocardiogram. They did it in the office and he would be getting a cut of the $$$$. The technician told me on the QT that he heard absolutely nothing wrong and couldn't understand why I was having it done. The reason: the MD knowing that I was a dentist sucked me into the "you are doing to die" fear tactics that were representative of the 1990's when more patients died from reactions to the antibiotics than from mitral valve prolapse or what ever the similar diagnosis was!!! This same MD also told me that I had symptoms of COPD just to charge me for an additional test. I was outta there!!!! Yeah, the person who can get on a treadmill to this very day for 30 plus minutes and not have an issue!



[+ not2rowdy]

I've been on blood pressure medication for years....So to get my blood pressure checked a few times a month I go to one of the local fire stations.

 

I’ve always questioned the validity of a single, isolated blood pressure check. I’m certain I suffer from “white smock syndrome”. I get nervous. That increases blood pressure. I suspect others have these same issues. It makes me wonder how many are on blood pressure medicine who probably don’t need to be.

 

I recently bought an inexpensive blood pressure monitor. I recognize it’s not “professional” grade but the idea is to track a trend - not just a single check in the doctor’s office when I’m nervous. The one I have is very simple to use and allows storing up to 90 checks. It automatically averages what’s in memory. The particular one I have is the Panasonic EW3109. About $45 on Amazon.

 

Then I use the built in “Health” app on my iPhone and manually enter the blood pressure and heart rate reading as data points. I try to take 2-3 reading throughout the day. I will show my data to my doctor when I next see him. Currently 126/83 and 73bps over 40 data points.

[maninsoma]

I’ve always questioned the validity of a single, isolated blood pressure check. I’m certain I suffer from “white smock syndrome”. I get nervous. That increases blood pressure. I suspect others have these same issues. It makes me wonder how many are on blood pressure medicine who probably don’t need to be.

 

I recently bought an inexpensive blood pressure monitor. I recognize it’s not “professional” grade but the idea is to track a trend - not just a single check in the doctor’s office when I’m nervous. The one I have is very simple to use and allows storing up to 90 checks. It automatically averages what’s in memory. The particular one I have is the Panasonic EW3109. About $45 on Amazon.

 

Then I use the built in “Health” app on my iPhone and manually enter the blood pressure and heart rate reading as data points. I try to take 2-3 reading throughout the day. I will show my data to my doctor when I next see him. Currently 126/83 and 73bps over 40 data points.

 

I bought an Omron bp checker a couple of years ago at the suggestion of my doctor. It is true that one's BP can vary quite a bit, especially if you've just exerted yourself or are stressed. I found that by taking multiple measurements over a period of 30-45 minutes at home I have a better idea of what my BP actually is versus just getting a single reading whenever I happen to go to my doctor's office. I also learned that some simple things can affect one's reading, so I am more mindful when getting my BP checked. It's best not to be holding in pee (if you have to go, go before your BP is checked); to sit with your feet flat on the floor; and to have your forearm resting on something about the height of your heart.

[+ Gar1eth]

I’ve always questioned the validity of a single, isolated blood pressure check. I’m certain I suffer from “white smock syndrome”. I get nervous. That increases blood pressure. I suspect others have these same issues. It makes me wonder how many are on blood pressure medicine who probably don’t need to be.

 

I recently bought an inexpensive blood pressure monitor. I recognize it’s not “professional” grade but the idea is to track a trend - not just a single check in the doctor’s office when I’m nervous. The one I have is very simple to use and allows storing up to 90 checks. It automatically averages what’s in memory. The particular one I have is the Panasonic EW3109. About $45 on Amazon.

 

Then I use the built in “Health” app on my iPhone and manually enter the blood pressure and heart rate reading as data points. I try to take 2-3 reading throughout the day. I will show my data to my doctor when I next see him. Currently 126/83 and 73bps over 40 data points.

 

I bought an Omron bp checker a couple of years ago at the suggestion of my doctor. It is true that one's BP can vary quite a bit, especially if you've just exerted yourself or are stressed. I found that by taking multiple measurements over a period of 30-45 minutes at home I have a better idea of what my BP actually is versus just getting a single reading whenever I happen to go to my doctor's office. I also learned that some simple things can affect one's reading, so I am more mindful when getting my BP checked. It's best not to be holding in pee (if you have to go, go before your BP is checked); to sit with your feet flat on the floor; and to have your forearm resting on something about the height of your heart.

 

Just a suggestion-while I don't trust the blood pressure taken by the nurse at my current health place (as I said earlier, her technique is awful) at other places I've trusted it more. Y'all should take your machines to your doctor's office or a fire station and compare simultaneous blood pressures from the machine with what the professionals obtain to make sure your machine is reasonably accurate.

 

Gman

[rvwnsd]

I'm due for an ECHO Stress test ... bad numbers and bad family history: father - MI; mother - MI; 3/4 grandparents - MI's; brother - MI; several cousins - MI's. Physical condition (incl BP) - weight - diet - exercise history has nothing to do with it. That gene is hiding in there!

 

I had an ECHO stress test last month because I was feeling too winded after doing moderate exercise. Turns out my heart is fine and we need to adjust my asthma meds. That said, I thought the test was fun. First, I got to see y heart working - that was cool! Then I got to play on the treadmill - fun! Then more of my heart - cool! Sadly, the cardiologist can't send me a video of the test.

 

Just a suggestion-while I don't trust the blood pressure taken by the nurse at my current health place (as I said earlier, her technique is awful) at other places I've trusted it more. Y'all should take your machines to your doctor's office or a fire station and compare simultaneous blood pressures from the machine with what the professionals obtain to make sure your machine is reasonably accurate.

 

Gman

 

Out of an abundance of caution I think we should all go to our local firehouses on a weekly basis to validate our blood pressure monitors. Especially when they are washing the fire truck and exercising.

[MikeBiDude]

Just a suggestion-while I don't trust the blood pressure taken by the nurse at my current health place (as I said earlier, her technique is awful) at other places I've trusted it more. Y'all should take your machines to your doctor's office or a fire station and compare simultaneous blood pressures from the machine with what the professionals obtain to make sure your machine is reasonably accurate.

 

Gman

I did take my simple $35 blood CVS pharmacy unit to my doctors, read almost exactly the same. My doc only had afternoon office hours (did lot$ of colonoscopy procedures all morning) and my blood pressure used to run high in afternoons, so I liked to check various times a day.

 

After years of working all "vectors" that impact high blood pressure, I made some personal life decisions re:alcohol, and currently my blood pressure is 110/70 every day.

[+ purplekow]

I had one of those years ago. The details are a bit fuzzy as this was 19 years ago. But I woke up in the middle of the night with this incredible chest pain. I realized it could be a heart attack. So being the smart, intelligent 36 year old I was, I drove myself to the ED:confused:.

 

I can't quite remember what happened after that, but the pain eventually went away. They decided it wasn't a heart attack. I went home. A few days later I was talking to an old friend from my university who was now a cardiologist. He said you should have a stress Echo. So I had him do it. He didn't see any problem with my coronary arteries. But he diagnosed me with moderate mitral regurgitation. He said it was moderate because of how far the 'jet' of blood through the leaky valve traveled backward-or something like that.

 

Well over the years I've had my mitral valve rechecked by the doctors. Most of them, even cardiologists, can't hear the leak. I've also had multiple ECHOS over the years. On the last Echo three years ago they couldn't even find any leakiness in my valve. I think my friend having seen the moderate leak had to do with me having exercised and really stressing my heart. In normal

circumstances apparently it doesn't leak very much. I had been worried whether it ran in families as my Dad's mitral valve was totally kaput. They tried to repair it. It didn't work. A year or so later they put in a titanium valve.

 

[uSER=9945]@funguy[/uSER] I'm hoping the results come out perfectly fine!! Is there a reason that they aren't doing a nuclear stress test? My limited understanding was that they were more sensitive.

 

Gman

 

PS I had the pain 2 more times over the next year. On the third episode the pain was so bad, I almost couldn't breathe. This time the ED said I had an elevation on my EKG. They put me overnight on a nitro drip (such a headache) in the Cardiac Intermediate Care Unit for monitoring. Come morning they've decided it's not a heart attack. So they do more investigating. An ultrasound shows that I have a few gallstones. They decide the pain is from my gallbladder. After that the next time I had the pain (it started occurring more frequently after that), I realized that the pain actually did start just below my ribs on the right and traveled up to the center of my chest.

 

The funny thing was that for months beforehand occurring multiple days a week in the mornings I had been having what I thought were severe hunger pangs. The pangs were weird because I have not eaten breakfast regularly since I was in junior high. Most mornings my first food was lunch. I couldn't understand why my stomach was all of a sudden reacting so badly to not eating in the morning when that had been normal for years.

 

It turns out the pangs weren't due to hunger. They were due to my gallbladder.thi

 

I tolerated the increasingly frequent gallbladder attacks for about two more months, and then finally had my gallbladder removed.

 

Gman

It is possible you had papillary muscle dysfunction related to an ischemic event resulting in transient mitral regurgitation. This is seen with a reasonable frequency in MI and angina. Of course, if you did not have an infarct, you might still have had a temporary ischemic event so there would be no MI and the MR would resolve when the papillary muscle returned to normal functioning with the return of blood flow.

Just as BP is a dynamic, changing readings throughout the day, so is the function of the various heart valves dynamic and changing.

As for prophylactic antibiotics, the recommendations have changed over the years. There is still some situations in which antibiotics should be given. I would hardly judge the prior use of antibiotics as overuse or abuse. Antibiotics were used as the available data suggested a benefit and in the cases of infective endocarditis, available treatment was not very effective and surgery to repair or replace valves was much riskier than it is now. People did die of these infections, including my mother's first husband.

A recent review of antibiotic prophylaxis, written less than a year ago: http://www.uptodate.com/contents/antibiotics-before-procedures-beyond-the-basics

[whipped guy]

As for prophylactic antibiotics, the recommendations have changed over the years. There is still some situations in which antibiotics should be given. I would hardly judge the prior use of antibiotics as overuse or abuse. Antibiotics were used as the available data suggested a benefit and in the cases of infective endocarditis, available treatment was not very effective and surgery to repair or replace valves was much riskier than it is now. People did die of these infections, including my mother's first husband.

A recent review of antibiotic prophylaxis, written less than a year ago: http://www.uptodate.com/contents/antibiotics-before-procedures-beyond-the-basics

I respectfully disagree. Contrary to what is stated in the link, in the real world physicians were prescribing antibiotics for mitral valve prolapse without regurgitation and also for patients who simply had a history of rheumatic fever, etc.etc.etc..... It might not have been the recommended protocol, but such was the reality of the situation. Bottom line... There was plenty of overuse and abuse. I even had a patient whose MD had him take a 250mg Penecillin a day simply due to having a history of rheumatic fever! If that ain't abuse I don't know what is!!!!!!!

[+ Gar1eth]

I respectfully disagree. Contrary to what is stated in the link, in the real world physicians were prescribing antibiotics for mitral valve prolapse without regurgitation and also for patients who simply had a history of rheumatic fever, etc.etc.etc..... It might not have been the recommended protocol, but such was the reality of the situation. Bottom line... There was plenty of overuse and abuse. I even had a patient whose MD had him take a 250mg Penecillin a day simply due to having a history or rheumatic fever! If that ain't abuse I don't know what is!!!!!!!

I thought after rheumatic fever you were supposed to take continual antibiotics for a long time-possibly forever.

 

Gman

[+ purplekow]

I respectfully disagree. Contrary to what is stated in the link, in the real world physicians were prescribing antibiotics for mitral valve prolapse without regurgitation and also for patients who simply had a history of rheumatic fever, etc.etc.etc..... It might not have been the recommended protocol, but such was the reality of the situation. Bottom line... There was plenty of overuse and abuse. I even had a patient whose MD had him take a 250mg Penecillin a day simply due to having a history of rheumatic fever! If that ain't abuse I don't know what is!!!!!!!

Unfortunately bad practitioners will always exist. All that clindamycin used by dentists leading to C diff diarrhea and all those excessive pain medications. "Take the pain medication until you can dig up the money for the procedure"

No one profession has a monopoly on abuse by bad practitioners.

On the other hand, the standard of care was and is to use antibiotics for certain procedures and that is not abuse.

[+ Gar1eth]

I respectfully disagree. Contrary to what is stated in the link, in the real world physicians were prescribing antibiotics for mitral valve prolapse without regurgitation and also for patients who simply had a history of rheumatic fever, etc.etc.etc..... It might not have been the recommended protocol, but such was the reality of the situation. Bottom line... There was plenty of overuse and abuse. I even had a patient whose MD had him take a 250mg Penecillin a day simply due to having a history of rheumatic fever! If that ain't abuse I don't know what is!!!!!!!

 

I thought after rheumatic fever you were supposed to take continual antibiotics for a long time-possibly forever.

 

Gman

 

Post Rheumatic Fever Recommendations:

 

Primary prophylaxis (treatment of streptococcal pharyngitis) dramatically reduces the risk of ARF and should be provided whenever a group A streptococcal pharyngitis is confirmed.

 

Secondary prevention is required to prevent additional streptococcal infections and is the critical step in management of ARF. Patients with a history of rheumatic fever are at a high risk of recurrent ARF, which may further the cardiac damage. The exact duration of chronic antimicrobial prophylaxis remains controversial, but the WHO guidelines are commonly used.[1] There had been concern that sustained benzathine penicillin as secondary prophylaxis would lead to the development of resistant strains of Streptococcus viridans, but a recent study found no support for this hypothesis.[32]

 

Rheumatic fever with carditis and clinically significant residual heart disease requires antibiotic treatment for a minimum of 10 years after the latest episode; prophylaxis is required until the patient is aged at least 40-45 years and is often continued for life.

 

 

Rheumatic fever with carditis and no residual heart disease aside from mild mitral regurgitation requires antibiotic treatment for 10 years or until age 25 years (whichever is longer).

 

Rheumatic fever without carditis requires antibiotic treatment for 5 years or until the patient is aged 18-21 years (whichever is longer).

 

Children given penicillin G benzathine at a dose of 1.2 million U IM q4wk experienced a recurrence rate of 0.4 cases per 100 patient-years of observation. ARF recurrence rates have been found to be even lower if penicillin is administered q3wk instead of q4wk. This regimen may be appropriate in patients with severe rheumatic heart disease. Weigh the benefits of a 3-week regimen against patient compliance and cost; compliance is often poor to start with, at least partially due to the pain of the injections.[15] Long-term administration of oral penicillin may be used in lieu of the intramuscular route. Erythromycin or sulfadiazine may be used in patients who are allergic to penicillin.[1, 6]

 

 

Gman