Indian J Pediat 48 : 451-455, 1981 SYMPOSIUM, PEDIATRIC CARDIOLOGY PART II Management of acute rheumatic fever S. Shrivastava, M.D., D.M., and R. Tandon, M.D. Management of rheumatic fever is outlined. It is emphasized that prevention of rheumatic fever is more important than treating the disease. Aspirin and steroids suppress the rheumatic inflammation but do not cure it. In the presence of cardiac involvement we prefer to use steroids as compared to aspirin. If congestive cardiac failure is present, the rrumagement must include steroids since aspirin treated patients have a higher morality. Key words : Rheumatic fever, management Rheumatic fever (R F) is an acme inflammatory disease characterized by fever, arthritis or arthralgia, carditis, subcutaneous nodules, erythema margina- turn and chorea. The diagnosis can be sus- pected clinically and substantiated by in- vestigations. However, there is no specific diagnostic test available to conclusively prove the diagnosis. Jones criteria, modi- fied and later revised by ,the American Heart Association are helpful in suggesting the diagnosis of acute RF (Fable 1). The purpose of this review is to outline the management of acute RF. The man- agement can be considered under the following headings: 1. Managment of acute stage. 2. Management of chorea. 3. Prevention of rheumatic fever and its recurrences. 4. Management of rheumatic heart disease. From the Department of Cardiology, All India Institute of Medical Sciences, New Delhi- 110029. Reprint requests : Dr. S. Shrivastava, Assistant Professor in Cardiology. Prevention of rheumatic fever and its recurrences were described in Part I of this symposium (May-June, 1981 Issue). Management of a patient with rheumatic heart disease is outside the scope of the present article. Management of acute rheumalic fever Once the diagnosis of RF is clear it is best to hospitalize the patient specially if there is cardiac involvement. Hospitaliza- tion ensures rest which may not be feasible in the setting of home environment in our country. Bed rest Initially strict bed rest is advisable specially in the presence of cardiac involve- ment. By reducing the work load of the heart it may reduce the residual damage to it. In patients without cardiac involve- ment the bed rest should be continued for at least two weeks after the erythro- cyte sedimentation rate has returned to normal. Patients who have cardiac involvement should be kept on bed rest for four to six weeks after the sedimenta- tion rate has returned to normal.