One Case of Severe Acute Rheumatic Carditis in Adults

Objectives Currently, the incidence of rheumatic fever has significantly decreased, and its clinical manifestations are mostly atypical. To enhance the attention to the diagnosis of rheumatic carditis, this article reports a case of severe acute rheumatic carditis caused by acute rheumatic fever. Methods The patient was admitted to the cardiology department due to chest tightness and shortness of breath, along with a fever. Patient was treated with continuous oxygen inhalation, diuresis, bronchodilation, cardiotonic therapy, cough suppression, anti-infection measures, etc. Atrial fibrillation occurred, along with chest tightness, shortness of breath, sitting-up breathing, paroxysmal cough, and coughing up a small amount of white frothy sputum. The patient’s condition worsened, and drug treatment was ineffective. The patient was transferred to the intensive care unit (ICU). Non-invasive ventilator-assisted breathing was provided, anti-infection treatment was carried out, dopamine and norepinephrine were used to improve circulation. Hemofiltration and vasoactive drugs were continued to maintain circulation, methylprednisolone was used for anti-inflammatory treatment, to correct arrhythmia and improve cardiac function. The vital signs gradually stabilized. Results After the above comprehensive treatment, the patient’s current physical condition is stable and there are no restrictions on their general physical activities. Conclusions Antimicrobial therapy, anti-inflammatory treatment, non-invasive ventilation and hemofiltration were the key measures. Starting from hemodynamic monitoring for treatment, aiming to ensure the perfusion of tissues and organs, and striving to maintain the oxygen supply to tissues and organs; appropriately using supportive measures to improve cardiac function is an important measure for the success of the treatment.