Echocardiographic Stigmata in the First Attack of Acute Rheumatic Fever as a Major Criterion for the Diagnosis of Rheumatic Carditis in Misan, Iraq Mohsin Khalid Obaid1, Aljawadi Hussein Fadhil Musa2,*, Ali Esraa Abd Al-Muhsen2 1Head of Internal Medicine Department, College of Medicine, Misan University, Misan, Iraq 2Assistant Professor, Pediatrics Department, College of Medicine, Misan University, Misan, Iraq *Corresponding author: Dr. Hussein Fadhil Musa Aljawadi Mobile: 009647814241052 E-mail: drhussein1969@gmail.com
Online published on 6 April, 2019. Abstract Background Doppler Echocardiography facility is usually available in the most areas of the world and its routine use in the initial diagnosis of rheumatic heart disease may promote early detection, much earlier that clinical examination does. Objectives To evaluate the utility of Doppler Echocardiography for the diagnosis of carditis in patients whom clinical examination did not indicate any evidence of carditis. To describe the spectrum of cardiac abnormalities in patients with primary episode acute rheumatic fever. Patients and Method A cross sectional and prospective study conducted during a period of five years in Misan province (South East Iraq). Referred patients for an echocardiographic evaluation in Al-Sader Teaching Hospital with diagnosis of acute rheumatic fever as first attack were selected. All patients were examined clinically then subjected to Doppler Echocardiographic evaluation in the first 48–72 hours of acute phase and 2 weeks later. Results A total of 36 patients with median age of 13±4.69 years and male predominance were presented with diagnosis of primary attack of acute rheumatic fever. The majority were presented with migratory polyarthritis (80.6%) and clinical carditis (44.4%). Clinical carditis was found in 16/36 patients while the remaining (20 patients) had no clinical carditis. On the other hand, Doppler Echocardiography confirmed the diagnosis of carditis in additional 10 cases without clinical carditis. About almost all patients with acute rheumatic carditis (25/26) had mitral valve/aortic valve thickness >4mm. Valvular regurgitations were constituted the major manifestation; mitral regurgitation was found in the majority (21/26 patients) followed by aortic and tricuspid regurgitation. Conclusion Doppler Echocardiography is more sensitive than a clinical assessment in the detection of carditis in patients with an initial attack of acute rheumatic fever. It is a useful method in identifying the subclinical mitral and aortic valvular disease when carditis cannot be detected clinically. Therefore, it is reasonable and valuable to support the addition of echocardiographic stigmata of rheumatic carditis to the current diagnostic criteria as an isolated major criterion by itself for the validation of rheumatic carditis with subclinical carditis. Top Keywords Rheumatic fever, carditis, echocardiography, Misan, Iraq. Top |