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Prescribed penidure injections, had swelling & pain in leg, done echocardiography. Correct or other treatment?

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Practicing since : 1988
Answered : 43 Questions
Hi Doc,
My sister was asked my the Dr to take pendura injection for every 21 days.He had problem in her leg it was swelled and she had pain in that.She has done Ecocardiography test, i have soft copy of the Ecocardiography report, I can send you .Can you please explain me is the treatment she was given is currect? Is there any other better treatment and what should I do next.
Posted Wed, 11 Apr 2012 in Heart Rate and Rhythm Disorders
Follow-up: Prescribed penidure injections, had swelling & pain in leg, done echocardiography. Correct or other treatment? 10 minutes later
Also I could read the patient Ecocardiography test report has mentation Final Impression :- Rheumatic Heart Disease: Mild MS(MVA=2.4 cm2 by planimetry and 2.2 cm2 by PHT),Mild AS(M.Grad=30.0 mmHg),
Mild AR,Dilated LA
Answered by Dr. Gopi A 18 hours later

Thanks for posting your query. I have gone through the information given by you.

Your sister is suffering from Rheumatic Heart Disease (RHD) which is a complication of streptococcal throat infection that she had many years back.

Our body forms antibodies against these bacteria to fight it but unfortunately a similar substance is there in our heart hence these antibodies also attack these tissues in the heart and damage it.

At present 2 valves are damaged for your sister though only mildly. The penidure injection that she has been advised is to prevent further infections with streptococci because repeated infections will result in rapid progression of the heart disease. If there are no further infection the damage to the valves can still progress though very slowly. The damage that is already there cannot be reversed.

You need to keep her on a close medical follow up get echocardiography done at least once in 1 or 2 years to check it's progression. If it progresses there is a possibility that she may require valve repair or replacement surgery. Though it is not likely to happen in the 5 to 8 years at least.

You need to watch out for symptoms like breathlessness on exertion and fatigue. To answer your question, there is no need for any other treatment at present but take the Penidure injections regularly and get regular check ups done.

Hope, I have answered your query. Please accept my answer in case you do not have further queries.

Above answer was peer-reviewed by
Follow-up: Prescribed penidure injections, had swelling & pain in leg, done echocardiography. Correct or other treatment? 3 days later
Hi Dr XXXXXXX .....nay thanks fro your reply.
I have few follow up question :-

1.Is there any chance that she is diagnoses wrong and I have do some testing to be more sure? I wanted to be more sure about it.

2.Do she has to take penidure injection for life long?

3.Is it very likely that she has to go for the valve replacement in future? or the injection will work fine?

4.What is approx valve replacement operation cost in India?

Answered by Dr. Gopi A 3 hours later
Thanks for following up.
1.)     If you have a doubt about the diagnosis or if you want to confirm it, you could show it to one more specialist.
2.)     Your sister will not need to take penicillin injections lifelong, but they would have to be continued till 45 years of age.
3.)     It is not possible to predict whether she would need valve replacement in the future or not and thus periodic checkups are required to monitor the patient on a regular basis. Also, progression cannot be prevented completely in rheumatic heart disease since the valves have already been damaged.
4.)     At present the likely cost of valve replacement in India is Rs. 3,00,000/.

I hope I have answered your query.
With regards,

Dr. A. Gopi
Above answer was peer-reviewed by
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