Frequency of Different Valvular Lesions of Rheumatic Heart Disease Presenting to a Tertiary Care Hospital (original) (raw)
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Pattern of Valvular Lesions in Rheumatic Heart Disease in a Tertiary Care Institute, Tamilnadu
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND Rheumatic heart disease (RHD) is a major contributor to morbidity and premature death in poor and developing countries like India. RHD predominantly affects young and working age group. Objective-To evaluate relative frequency of the various cardiac valvular lesions in Rheumatic heart disease (RHD) in patients who underwent Echocardiogram in the Department of Cardiology, Thanjavur Medical College, Thanjavur, Tamilnadu. MATERIALS AND METHODS This retrospective descriptive study was conducted at Cardiology Department based on transthoracic two dimensional echocardiogram reports, diagnosed as RHD (Rheumatic heart disease) from January 2016 to December 2016. The reports were retrieved from computerised database and demographic features like age, sex, type of valvular lesion were analysed. RESULTS Out of 17,625 patients who underwent echocardiogram in the Department of Cardiology, 428 patients (2.4 %) were diagnosed with rheumatic heart disease. The commonly affected age group was 21 to 40 years. The distribution being 120 males (28%), 288 females (67.2%) and 20 children (4.6%). Mitral Regurgitation was the predominant valvular lesion affecting 328 (76.6%) patients with female preponderance of 239 (72.8%) patients. The second most common valvular lesion was Mitral Stenosis. It was diagnosed in 287 patients constituting 67.05%. The incidence was most common in females (205 cases, 71%) when compared to males (82 cases 29%). Of those 287 patients, 139 (48.4%) patients had severe MS and 92 (32.0%) had moderate MS. Aortic Regurgitation (AR) was present in 126 (29.4%) patients and almost always (99 %) in combination. Mixed valvular lesions (MS with MR) were present in 117 (27.3%) of patients. The least common lesion was Aortic stenosis (AS) noted in 24 (5.6%) patients. Out of 118 patients with multivalvular lesions, MS with MR with AR were found in 65 (55.08%) patients. CONCLUSION The most common valvular lesion reported in our study was multivalvular lesion. The predominant pure lesion was Mitral regurgitation followed by Mitral stenosis, Aortic regurgitation and MS with MR.
A study of spectrum of rheumatic heart disease in a tertiary care hospital in Central Nepal
IJC Heart & Vasculature, 2017
Background and aims: Rheumatic heart disease is one of the most common cause for heart failure and associated mortalities/morbidities in the young population in developing countries like Nepal imparting huge familial, social and manpower burden. Materials and methods: This is a hospital based descriptive cross-sectional study during June 2014 to April 2016 over a period of 22 months at College of Medical Sciences-Bharatpur including 235 patients with clinical and/ or echocardiographic evidence of definite rheumatic heart disease. Results: The age of the patients ranged from 7 to 76 years with mean age 39.82 ± 4.2 years with female preponderance (F:M = 2.1:1) (p b 0.01). Majority of the rheumatic heart disease patients belonged to 30-44 years (28.78%) followed by 15-29 years (25.75%) and 45-59 years (25.00%). Majority belonged to the low socioeconomic status (60.60%) (p b 0.05). The predominantly involved isolated valve was mitral in 110 patients (46.80%) followed by isolated aortic valve in 22 patients (9.36%) and 79 (33.62%) had dual valvular involvement. The common rheumatic valvular lesions were pure mitral stenosis in 32 (13.61%), isolated mitral regurgitation in 58 (24.68%), combined mitral stenosis/regurgitation in 36 (15.32%), combined mitral/aortic regurgitation in 23 (9.78%) and combined aortic stenosis/regurgitation in 18 (7.66%) patients with few overlappings. The common complications encountered were heart failure in 90 (38.30%) and arrhythmias in 124 (51.00%) patients.130 patients (55.32%) received injectable benzathine penicillin whereas 45 patients (19.15%) preferred oral penicillin V. Surgical intervention was done in 54 (22.97%) patients. 12 (5.10%) expired in the CCU during the course of treatment. Conclusion: RHD is a leading cause of heart failure among young populations with requirement of prolonged duration of medical treatment and many of them requiring surgery.
Rheumatic heart disease revisited
Journal of Cardiovascular Medicine, 2012
Background The burden of rheumatic heart disease (RHD) continues to be a major contributor to morbidity and premature death in poor and developing countries. We investigated patterns of valvular involvement in patients with RHD as observed in a large tertiary care hospital in eastern Nepal. Methods We retrospectively reviewed transthoracic echocardiography reports from patients diagnosed with RHD between June 1999 and February 2011. Results Among 10 860 transthoracic echocardiography studies, 1055 female and 658 male patients were diagnosed with RHD, 25.7% of the patients being below 20 years of age. Mitral regurgitation was the most common valvular lesion across all age groups irrespective of sex (n U 1321, 77.1%). Female patients were significantly older as compared to male patients at the time of presentation (32.8 W 15.2 versus 28.5 W 15.4 years; P < 0.001) and more commonly presented with mitral stenosis as compared to male patients (62.8 versus 51.5%; P < 0.001), with a peak between the age of 30 and 49 years. Conversely, aortic regurgitation was more common in men as compared to women (55.6 versus 48.9%; P U 0.007). Involvement of both the mitral and the aortic valve was observed in 49.8% of the patients and was more common in men as compared to women (52.7 versus 47.8%; P U 0.047). Conclusion In this consecutive cohort of patients with RHD in Nepal differential patterns of valvular involvement are observed across sex and age categories.
Echocardiographic Profile of Rheumatic Heart Disease at a Tertiary Cardiac Centre
J Ayub Med Coll …, 2009
Background: Rheumatic Heart Disease (RHD) continues to be a major public health problem in developing countries like Pakistan. Objective of this cross sectional-analytical study was to analyze the severity of valvular lesions on echocardiography in patients pre-diagnosed with RHD. Methods: The transthoracic echocardiographic records of RHD patients from 2004 to 2008 were retrospectively reviewed for type and degree of valvular involvement according to AHA/ACC guidelines. Results: A total of 13,414 patients [7,219 Males (53.8%), 6,195 Females (46.2%)] ranging from 11 to 90 years with a mean age of 42.33±18.976 were studied. On echocardiography, 7,500 (56%) had mitral regurgitation (8.8% severe MR), 6,449(48.2%) had tricuspid regurgitation (7.1% severe TR) and 5,550 (41.4%) had aortic regurgitation (4.8% severe AR). MS was detected in 2,729 (20.3%) patients (15.3% severe MS), AS in 102 (0.8%) and TS in 31 (0.2%) patients. Mixed mitral valve disease was seen in 3,185 (23.7%), mixed aortic valve disease in 222 (1.7%) and mixed tricuspid valve disease in 47 (0.4%) patients. All three valves were involved in 2,826 (21.06%) patients, combination of mitral and aortic valves in 3,103 (23.13%), mitral and tricuspid in 3,784 (28.2 %), and mitral only in 3,701 (27.59%) patients. There was some mitral valve abnormality in all patients. Conclusion: Mitral valve was most commonly affected, while regurgitant lesions were more common than stenotic lesions, and most severe in younger patients. All valvular lesions had almost an equal distribution among the sexes, except aortic regurgitation, which was more common in females. Therefore, echocardiography should be done routinely for patients with RHD, focusing on younger population, to facilitate diagnosis and definitive treatment before complications set in.
Journal of Liaquat University of Medical & Health Sciences, 2006
enrolled in the study. Demographic details of patients such as age, sex, socioeconomic status as well as their symptoms such as dysponea, palpitation and chest pain were noted on a proforma. Number of rheumatic fever attacks in the past were also noted. Patients were examined carefully for cardiac valvular lesions and for signs of acute rheumatic fever. Patients underwent different investigations such as blood complete picture, ESR, ASO titre, ECG, X-ray chest, echocardiography and Doppler. All patients had their calcium levels and collagen profile checked to exclude non rheumatic causes of valvular heart disease. RESULTS: One hundred adult patients of chronic rheumatic heart disease were studied for various valvular sequelae. Out of 100 patients studied, 49 (49%) patients were males and 51 (51%) were females. Seventy-three (73%) patients were below 30 years of age (Group A) and 27 (27%) patients were above 30 years of age (Group B). Patients age ranged between 12 and 60 years. Forty-eight (48%) patients had predominant mitral stenosis. Forty-two (42%) patients had predominant mitral regurgitation. Nine (9%) patients had aortic regurgitation and one (1%) had aortic stenosis along with mitral valve disease. CONCLUSION: From this study, it is concluded that mitral valve stenosis is frequently observed than mitral regurgitation and aortic valve is least affected, therefore, in every case of chronic rheumatic fever mitral valve should be thoroughly examined.
Journal of clinical and preventive cardiology, 2021
Background and aims: Rheumatic heart disease is one of the most common cause for heart failure and associated mortalities/morbidities in the young population in developing countries like Nepal imparting huge familial, social and manpower burden. Materials and methods: This is a hospital based descriptive cross-sectional study during June 2014 to April 2016 over a period of 22 months at College of Medical Sciences-Bharatpur including 235 patients with clinical and/ or echocardiographic evidence of definite rheumatic heart disease. Results: The age of the patients ranged from 7 to 76 years with mean age 39.82 ± 4.2 years with female preponderance (F:M = 2.1:1) (p b 0.01). Majority of the rheumatic heart disease patients belonged to 30-44 years (28.78%) followed by 15-29 years (25.75%) and 45-59 years (25.00%). Majority belonged to the low socioeconomic status (60.60%) (p b 0.05). The predominantly involved isolated valve was mitral in 110 patients (46.80%) followed by isolated aortic valve in 22 patients (9.36%) and 79 (33.62%) had dual valvular involvement. The common rheumatic valvular lesions were pure mitral stenosis in 32 (13.61%), isolated mitral regurgitation in 58 (24.68%), combined mitral stenosis/regurgitation in 36 (15.32%), combined mitral/aortic regurgitation in 23 (9.78%) and combined aortic stenosis/regurgitation in 18 (7.66%) patients with few overlappings. The common complications encountered were heart failure in 90 (38.30%) and arrhythmias in 124 (51.00%) patients.130 patients (55.32%) received injectable benzathine penicillin whereas 45 patients (19.15%) preferred oral penicillin V. Surgical intervention was done in 54 (22.97%) patients. 12 (5.10%) expired in the CCU during the course of treatment. Conclusion: RHD is a leading cause of heart failure among young populations with requirement of prolonged duration of medical treatment and many of them requiring surgery.
Rheumatic Heart Disease Burden and Need of Cardiovascular Surgery Service in Bharatpur Hospital
Journal of National Heart and Lung Society Nepal
Background: Rheumatic heart disease is one of the major public health concerns in Nepal. Depending on the severity of valvular involvement, these cases are managed either medically or surgically. As our centre is planning to develop cardiovascular surgery, we wanted to study the burden of valvular cases requiring on surgical management in our hospital. Methods: A cross-sectional study was conducted in the Department of Cardiology, Bharatpur Hospital, Chitwan, Nepal. During one year 4636 echocardiography conducted, 220 rheumatic heart disease cases were identified and included in the study. Results: The Mean±SD age was 24.5±12.4 years. Eighty percent subjects had valvular lesions suitable for medical management. Twenty percent subjects had severe valvular lesions requiring surgery or intervention. Out of these, only 30 subjects (13.6%) were operable, 4 (2.2%) were severe mitral stenosis cases suitable for balloon valvotomy and 10 subjects (4.5%) were unfit for surgery because of redu...
Prevalence of Rheumatic Heart Disease in Mathagadi Village Development Committee of Palpa District
Journal of National Heart and Lung Society Nepal, 2022
Introduction: Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. There is increasing burden of these diseases especially when it comes to a developing country like Nepal. The survey was done to determine the prevalence of Rheumatic heart disease and its burden. Methods: A Community based cross sectional study was done as a part of a demographic survey conducted among the residents of Mathagadi VDC of Palpa district. Cardiac auscultation and transthoracic echocardiography were performed. Abnormal findings on auscultation (murmurs, abnormal heart sounds) were further evaluated with the help of screening echocardiography by Cardiologist. Results: Out of total 2795 people screened, 37 individuals were found to have RHD, confirmed with a 2D echocardiographic findings. Mitral regurgitation was found to be the predominant lesion with 13 cases. Conclusion: The study revealed a large of proportion of cardiovascular diseases in Mathagadi VDC. It became clear that due to lack of proper health services, a large of number of cases may be either undiagnosed or under treated.
Journal of Nepal Medical Association
Introduction: Valvular heart disease continues to cause significant morbidity and mortality around the world, with rheumatic heart disease accounting for the bulk of cases in developing nations. The aim of this study is to find out the prevalence of rheumatic heart disease among patients with valvular heart disease admitted to the in-patient department of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted from December, 2018 to December, 2020 at a tertiary care centre after receiving ethical approval from the Institutional Review [Reference number: 395 (6-11) e2 077/078]. Patients of age ≥18 years presenting with valvular manifestations of any disease diagnosed by transthoracic echocardiography were included and patients other than Nepalese nationals were excluded. Convenience sampling was done and a sample size of 327 was taken. Data were collected, entered and analyzed using the Statistical Package for the Social Sciences version 22.0. Point estimat...
Pattern of rheumatic heart disease in patients admitted at tertiary care centre of Nepal
Nepalese Heart Journal, 2018
Background and Aims: As in other developing countries, Rheumatic Heart Disease (RHD) remains a major public health problem in Nepal. The most commonly affected people are children and adults in their productive years of age. The major contributing factors for high prevalence of Rheumatic Heart Disease in developing countries are poverty, illiteracy and limited access to healthcare services. The study was done to assess the basic pattern of Rheumatic Heart Disease among patients admitted at tertiary care center of Nepal: Shahid Gangalal National Heart Center.Methods: It is a cross sectional prospective study done among the patients admitted in Shahid Gangalal National Heart Center, Kathmandu.Results: RHD was more common among patients of age group 10-40 years, the most common age being 31-40 years (28.5%), with the male female ratio 1:1.6. Majority of the admitted patients had come from Central Development Region, and least number of patients had come from Far Western Region. About 4...