Clinical Characteristics, Echocardiographic Features And Short-Term Outcomes of Children with Rheumatic Heart Diseas

Hafiz Muhammad Anwar-ul-Haq; Muhammad Sohail Arshad; Mudasser Andan; Hira Afsheen; Sobia Tabassum

doi:10.51253/pafmj.v75iSUPPL-6.8669

Authors

Hafiz Muhammad Anwar-ul-Haq Department of Pediatric Cardiology, Children’s Hospital & Institute of Child Health, Multan Pakistan
Muhammad Sohail Arshad Department of Pediatric Cardiology, Children’s Hospital & Institute of Child Health, Multan Pakistan
Mudasser Andan Department of Pediatric Cardiology, Children’s Hospital & Institute of Child Health, Multan Pakistan
Hira Afsheen Department of Pediatric Cardiology, Children’s Hospital & Institute of Child Health, Multan Pakistan
Sobia Tabassum Department of Obstetrics & Gyne, Nawab Sir Sadiq Abbasi Hospital, Bahawalpur Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-6.8669

Keywords:

Echocardiography, mitral regurgitation, rheumatic fever, rheumatic heart disease

Abstract

Objective: To find out the clinical characteristics, echocardiographic features and short-term outcomes in children with rheumatic heart diseases (RHD).

Study Design: Prospective longitudinal study

Place and Duration of Study: The department of pediatric cardiology, “Children’s Hospital & Institute of Child Health, Multan” from Sep 2021-Feb 2022.

Methodology: A total of 73 children of both genders aged 4 to 18 years with RHD were included. Clinical characteristics, presenting complaints and echocardiographic features were noted. Duration of stay among children admitted and managed as well as in-hospital outcomes in terms of mortality were recorded

Results: Out of 73 children with RHD, 44(60.3%) were boys. Mean age was 11.78±3.62 years. Breathlessness, feeling of rapid ponding of heart-beat and orthopnea were the most frequent presenting complaints in 50(68.5%), 46(63.0%) and 41(56.2%) children respectively. Primary prophylaxis for ARF/RHD was reported in 6(8.2%) children. Echocardiographic assessment revealed mitral regurgitation in 71(97.3%), mitral stenosis 27(37.0%), aortic regurgitation 68(93.2%), left ventricular systolic dysfunction 50(68.5%) and pulmonary hypertension in 51(69.9%) children. Mean duration of hospital stay among admitted children was 12.57±2.77 days. Mortality was noted in 2(2.7%) children.

Conclusion: Majority of the children with RHD are diagnosed late that exposes them to increased risk of undiagnosed valvular disorders. Palpitation, orthopnea and breathlessness were the most frequent presenting clinical features of RHD. Mitral regurgitation and aortic regurgitation were the most common echocardiographic findings.

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References

1. Joseph N, Madi D, Kumar GS, Nelliyanil M, Saralaya V, Rai S. Clinical spectrum of rheumatic Fever and rheumatic heart disease: a 10 year experience in an urban area of South India. N Am J Med Sci. 2013; 5(11): 647-652.

2. Animasahun BA, Madise Wobo AD, Itiola AY, Adekunle MO, Kusimo OY, Thomas FB. The burden of rheumatic heart disease among children in Lagos: how are we fairing?. Pan Afr Med J. 2018; 29: 150.

3. Zuhlke LJ, Steer AC. Estimates of the Global Burden of Rheumatic Heart Disease. Global Heart. 2013; 8(3): 189–195. https://doi: 10.1016/j.gheart.2013.08.008

4. Carapetis JR. Rheumatic heart disease in developing countries. N Engl J Med. 2007; 357(5): 439-441.

5. Riaz A, Hanif MI, Khan IH, Hanif A, Mughal S, Anwer A. Quality of life in patients with rheumatic heart disease. J Pak Med Assoc. 2018; 68(3): 370-375.

6. Akhtar N, Sadiq M, Chagani H, Hafeez A, Rizvi FH, Mehboob M. Guidelines for prevention of Rheumatic fever and rheumatic heart disease. Pak J Cardiol 2004; 15: 136–48.

7. Rizvi SF, Khan MA, Kundi A, Marsh DR, Samad A, Pasha O. Status of Rheumatic heart disease in rural Pakistan. Heart 2004; 90(4): 394–399.

8. Ilyas M, Peracha MA, Ahmed R, Khan N, Ali N, Janjua M. Prevalence and pattern of rheumatic heart disease in the Frontier Province of Pakistan. J Pak Med Assoc 1979; 29(8): 165–168.

9. Makrexeni ZM, Pepeta L. Clinical presentation and outcomes of patients with acute rheumatic fever and rheumatic heart disease seen at a tertiary hospital setting in Port Elizabeth, South Africa. Cardiovasc J Afr. 2017; 28(4): 248-250. https://doi:10.5830/CVJA-2017-019

10. Mach DS. Revised Jones Criteria for acute rheumatic fever; Ten points to remember. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/05/08/15/22/revision-of-the-jones-criteria-for-the-diagnosis-of-acute-rheumatic-fever (accesses on 30th January 2022)

11. Lilyasari O, Prakoso R, Kurniawati Y, Roebiono PS, Rahajoe AU, Sakidjan I, et al. Clinical profile and management of rheumatic heart disease in children and young adults at a tertiary cardiac center in Indonesia. Front Surg. 2020; 7: 47.

12. Shrestha NR, Kalesan B, Karki P, Sherpa K, Basnet A, Urban P, et al. Rheumatic heart disease: pilot study for a population based evaluation of prevalence and cardiovascular outcomes among schoolchildren in Nepal. BMJ Open 2012; 2(5): e001616.

13. Cilliers AM. Rheumatic fever and rheumatic heart disease in Gauteng on the decline: Experience at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. S Afr Med J. 2014; 104(9): 632-4. https://doi: 10.7196/samj.8318.

14. Gray LA, D'Antoine HA, Tong SYC, McKinnon M, Bessarab D, Brown N, et al. Genome-wide analysis of genetic risk factors for Rheumatic Heart Disease in Aboriginal Australians provides support for pathogenic molecular mimicry. J Infect Dis. 2017; 216(11): 1460-1470.

15. Abrar A, Khan S, Rehman MU, Jan T, Faisal M, Khan N. Frequency of rheumatic heart disease in patients undergoing echocardiography in district dera ismail khan. Gomal J Med Sci. 2014; 12(3): 147-150.

16. Muhamed B, Shaboodien G, Engel ME. Genetic variants in rheumatic fever and rheumatic heart disease. Am J Med Genet C Semin Med Genet. 2020; 184(1): 159-177.

17. Antunes MJ. The global burden of rheumatic heart disease: Population-related differences (it is not all the same!). Braz J Cardiovasc Surg. 2020; 35(6): 958-963.

18. Dougherty S, Beaton A, Nascimento BR, Zühlke LJ, Khorsandi M, Wilson N. Prevention and control of rheumatic heart disease: Overcoming core challenges in resource-poor environments. Ann Pediatr Cardiol. 2018; 11(1): 68-78.