Clinical and Echocardiographic assessment of Patient's with Rheumatic Heart Disease

Abstract

Introduction: In developed countries rheumatic heart disease (RHD) have become uncommon health problems. On the contrary, in the developing countries like Nepal they remain the leading cause of heart disease in children and young adults augmenting morbidity and mortality. The prevalence of RHD varies considerably through the world. The global average prevalence rate of RHD was 2.2/1000 ranging between 0.1 and 12.6 according to World Health Organization (WHO).

Community based data are not available regarding the prevalence and distribution of RHD whereas recent epidemiological data are limited to school surveys and facility based reports. Because of low enrollment rates and frequent absenteeism, these studies are unlikely to reflect accurately the epidemiology of RHD in Nepal. The aims of this study were to analyze the clinical presentation pattern of the involvement of various valves and complication in established RHD. To assess the accuracy of clinical evaluation of valvular heart disease to compare it with echocardiographic evaluation.

Methods: Fifty consecutives cases of RHD, attending the outpatient department (OPD), of Tribhuvan University Teaching Hospital fulfilling the criteria, formed the material for the present study. Cases were examined in detail with record of physical findings made and cardiovascular examination done in each case. All the cases were scrutinized to detail echocardiographic study using Hitachi EUB 555, 12 lead EKG, chest x-ray and laboratory test. Design of the study was carried out in prospective, cross sectional study.

Results: The distributions of the various valvular lesions were noted singly and in combination. Females were more commonly affected 80% than males 20%. Majority of the patient studied had past history of rheumatic fever (72%). Mitral stenosis (MS) was noted in 38 (76%) clinically and 45 (90%) were diagnosed by echo. Pure MS were found in 4 cases (8%). Mitral Regurgitation (MR) was the second most common lesion clinically, in 29 (58%) and 44 (88%) by echocardiography.