Rheumatic heart disease (RHD) is an important cause of heart disease globally. Its management can encompass medical and procedural (catheter and surgical) interventions. Literature pertaining to the medical management of RHD from PubMed 1990-2016 and via selected article reference lists was reviewed. Areas included symptom management, left ventricular dysfunction, rate control in mitral stenosis, atrial fibrillation, anticoagulation, infective endocarditis prophylaxis, and management in pregnancy. Diuretics, angiotensin blockade and beta-blockers for left ventricular dysfunction, and beta-blockers and If inhibitors for rate control in mitral stenosis reduced symptoms and improved left ventricular function, but did not alter disease progression. Rhythm control for atrial fibrillation was preferred, and where this was not possible, rate control with beta-blockers was recommended. Anticoagulation was indicated where there was a history of cardioembolism, atrial fibrillation, spontaneous left atrial contrast, and mechanical prosthetic valves. While warfarin remained the agent of choice for mechanical valve implantation, non-vitamin K antagonist oral anticoagulants may have a role in RHD-related AF, particularly with valvular regurgitation. Evidence for anticoagulation after bioprosthetic valve implantation or mitral valve repair was limited. RHD patients are at increased risk of endocarditis, but the evidence supporting antibiotic prophylaxis before procedures that may induce bacteremia is limited and recommendations vary. The management of RHD in pregnancy presents particular challenges, especially regarding decompensation of previously stable disease, the choice of anticoagulation, and the safety of medications in both pregnancy and breast feeding.

中文翻译：

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风湿性心脏病的医疗管理：证据的系统评价。

风湿性心脏病（RHD）是全球范围内心脏病的重要原因。它的管理可以包括医疗和程序（导管和外科）干预。对1990-2016年PubMed中有关RHD医疗管理的文献进行了综述，并通过选定的文章参考文献进行了综述。领域包括症状管理，左心室功能障碍，二尖瓣狭窄率控制，心房纤颤，抗凝，预防感染性心内膜炎和妊娠管理。利尿剂，血管紧张素阻滞剂和β受体阻滞剂可治疗左心室功能障碍，β受体阻滞剂和If抑制剂可控制二尖瓣狭窄的发生率，可减轻症状并改善左心室功能，但不会改变疾病的进展。最好控制心房颤动的节奏，如果不可能，建议使用β受体阻滞剂控制心率。有心脏栓塞，心房纤颤，自发左心房造影和人工瓣膜病史的患者应进行抗凝治疗。尽管华法林仍然是机械瓣膜植入的首选药物，但非维生素K拮抗剂口服抗凝剂可能在RHD相关性房颤中起作用，尤其是在瓣膜返流时。生物瓣膜植入或二尖瓣修复后抗凝的证据有限。RHD患者患心内膜炎的风险增加，但是在可能导致菌血症的手术之前支持抗生素预防的证据有限，建议也有所不同。妊娠RHD的管理面临特殊挑战，尤其是在先前稳定的疾病的代偿失调方面，