Therapy of Severe Rheumatic Carditis

ALTHOUGH adrenocortical steroid therapy has been available for 14 years, its value in acute rheumatic fever still remains controversial. The Cooperative Study 1 failed to demonstrate any significant difference between aspirin and steroids with regard to their effect on residual heart disease. On the other hand, extensive data collected at the House of the Good Samaritan 2 have shown that steroids in large dosage cause a considerably higher incidence of regression and disappearance of significant murmurs than does aspirin. The study of Dorfman et al.,3 which evaluates the effect of prolonged therapy with aspirin, steroids, and the combination of both drugs, comes to the same conclusion. Our clinical experience for some time has shown that the difference in results with steroids and aspirin therapy is especially striking in very ill patients with rheumatic carditis and that in such patients steroid therapy may be lifesaving. Because most clinicians have had the same experience, aspirin has, since the advent of steroids, rarely been used in very severe rheumatic carditis. This fact has hindered the collection of reliable data comparing the effect of aspirin with that of steroids in severe rheumatic carditis and explains why such data cannot be found in the medical liter-