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12. Other conditions
•W ith globa l a nd le ft-s id e d he a r t fa ilu r e , the nitr a te d e r iv a tiv e s m a y be
u s e d in c a s e
of s igns of intole r a nc e to A C E inhibitor s (c hr onic c ou gh, r e na l im p a ir m e nt,
issoesvorebirde dinitrate P O : s ta r t w it h 1 0 t o 1 5 m g/ d a y in 2 or 3 d iv id e d d os e s a
hyp ote ns ion).
inc r e a s e to the e ffe c tiv e d os e , u s u a lly a r ou nd 1 5 to 6 0 m g/ d a y. V e r y
high d os e s (u p
to 2 4 0 m g/ d a y) m a y be ne c e s s a r y.
•W ha te v e r the tr e a tm e nt p r e s c r ibe d , m onitor ing s hou ld be r e gu la r :
c he c king c linic a l
im p r ov e m e nt a nd tr e a tm e nt tole r a nc e :
- c lin ic a l m on it or in g c on s is t s of e v a lu a t in g t h e w e igh t , blood p r e s s u r e ,
p u ls e
(r hythm d is tu r ba nc e s ) a nd the p r ogr e s s of s igns (d ys p noe a , oe d e m a ,
e tc .);
- la bor a tor y m onitor ing is a d a p te d a c c or d ing to the tr e a tm e nt.
Treatment of specific aetiologies
Hypertension (s e e p a ge 3 0 5 ); anaemia (s e e p a ge 3 7 )
Cardiovascular or “wet” beriberi from vitamin B1 deficiency
thiamine IM or IV
C hild r e n: 2 5 to 5 0 m g/ d a y for s e v e r a l d a ys
A d u lts : 5 0 to 1 0 0 m g/ d a y for s e v e r a l d a ys
T bheennzacthhinaenbgeenzytolpnoircaillilntrIeMa tm e nt w ith thiamine P O
C hild r e n a nd a d u lts : 3 to 5 m g onc e d a ily for 4 to 6 w e e ks
Acute rheumatic fever
– A ntibiotic tr e a tm e nt
pCrehdnildisorleonne uPnOd e r 3 0 kg: 6 0 0 0 0 0 IU a s a s ingle d os e
C hild r e n ov e r 3 0 kg a nd a d u lts : 1 .2 M IU a s a s ingle d os e
– A nti-infla m m a tor y tr e a tm e nt
Sta r t w ith acetylsalicylic acid P O : 5 0 to 1 0 0 m g/ kg/ d a y
If the fe v e r or c a r d ia c s igns p e r s is t, r e p la c e w ith a c or tic os te r oid :
C hild r e n: 1 to 2 m g/ kg/ d a y
A d u lts : 6 0 to 1 2 0 m g/ d a y
C on tin u e t h is t r e a t m e n t for 2 t o 3 w e e ks a fte r n or m a lis a t ion of th e
e r yt h r oc yt e
s e d im e nta tion r a te (E SR ), the n d e c r e a s e the d os e s p r ogr e s s iv e ly (ov e r 2
w e e ks ).
T o a v oid a r e la p s e , r e s u m e t h e a c e tyls a lic ylic a c id tr e a tm e n t in
p a r a lle l w ith th e
d e c r e a s e in p r e d nis olone d os e . T he a c e tyls a lic ylic a c id tr e a tm e nt is
c ontinu e d for 2 to
3 w e e ks a fte r the c or tic os te r oid s a r e fu lly s top p e d .
– Se c ond a r y p r op hyla xis
P r op hyla c tic tr e a tm e nt la s ts for s e v e r a l ye a r s (u ntil 1 8 ye a r s old , e v e n u ntil
2 5 ye a r s
•W ith globa l a nd le ft-s id e d he a r t fa ilu r e , the nitr a te d e r iv a tiv e s m a y be
u s e d in c a s e
of s igns of intole r a nc e to A C E inhibitor s (c hr onic c ou gh, r e na l im p a ir m e nt,
issoesvorebirde dinitrate P O : s ta r t w it h 1 0 t o 1 5 m g/ d a y in 2 or 3 d iv id e d d os e s a
hyp ote ns ion).
inc r e a s e to the e ffe c tiv e d os e , u s u a lly a r ou nd 1 5 to 6 0 m g/ d a y. V e r y
high d os e s (u p
to 2 4 0 m g/ d a y) m a y be ne c e s s a r y.
•W ha te v e r the tr e a tm e nt p r e s c r ibe d , m onitor ing s hou ld be r e gu la r :
c he c king c linic a l
im p r ov e m e nt a nd tr e a tm e nt tole r a nc e :
- c lin ic a l m on it or in g c on s is t s of e v a lu a t in g t h e w e igh t , blood p r e s s u r e ,
p u ls e
(r hythm d is tu r ba nc e s ) a nd the p r ogr e s s of s igns (d ys p noe a , oe d e m a ,
e tc .);
- la bor a tor y m onitor ing is a d a p te d a c c or d ing to the tr e a tm e nt.
Treatment of specific aetiologies
Hypertension (s e e p a ge 3 0 5 ); anaemia (s e e p a ge 3 7 )
Cardiovascular or “wet” beriberi from vitamin B1 deficiency
thiamine IM or IV
C hild r e n: 2 5 to 5 0 m g/ d a y for s e v e r a l d a ys
A d u lts : 5 0 to 1 0 0 m g/ d a y for s e v e r a l d a ys
T bheennzacthhinaenbgeenzytolpnoircaillilntrIeMa tm e nt w ith thiamine P O
C hild r e n a nd a d u lts : 3 to 5 m g onc e d a ily for 4 to 6 w e e ks
Acute rheumatic fever
– A ntibiotic tr e a tm e nt
pCrehdnildisorleonne uPnOd e r 3 0 kg: 6 0 0 0 0 0 IU a s a s ingle d os e
C hild r e n ov e r 3 0 kg a nd a d u lts : 1 .2 M IU a s a s ingle d os e
– A nti-infla m m a tor y tr e a tm e nt
Sta r t w ith acetylsalicylic acid P O : 5 0 to 1 0 0 m g/ kg/ d a y
If the fe v e r or c a r d ia c s igns p e r s is t, r e p la c e w ith a c or tic os te r oid :
C hild r e n: 1 to 2 m g/ kg/ d a y
A d u lts : 6 0 to 1 2 0 m g/ d a y
C on tin u e t h is t r e a t m e n t for 2 t o 3 w e e ks a fte r n or m a lis a t ion of th e
e r yt h r oc yt e
s e d im e nta tion r a te (E SR ), the n d e c r e a s e the d os e s p r ogr e s s iv e ly (ov e r 2
w e e ks ).
T o a v oid a r e la p s e , r e s u m e t h e a c e tyls a lic ylic a c id tr e a tm e n t in
p a r a lle l w ith th e
d e c r e a s e in p r e d nis olone d os e . T he a c e tyls a lic ylic a c id tr e a tm e nt is
c ontinu e d for 2 to
3 w e e ks a fte r the c or tic os te r oid s a r e fu lly s top p e d .
– Se c ond a r y p r op hyla xis
P r op hyla c tic tr e a tm e nt la s ts for s e v e r a l ye a r s (u ntil 1 8 ye a r s old , e v e n u ntil
2 5 ye a r s
