ROLE OF ECHOCARDIOGRAPHY IN DIAGNOSING SUBCLINICAL CASES OF ACUTE RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE IN DEVELOPING COUNTRIES
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 10
Abstract
BACKGROUND The Acute Rheumatic Fever (ARF) and its sequelae Rheumatic Heart Disease (RHD) continue to be a major cause of cardiac morbidity and mortality in developing countries and diagnosing ARF solely on Jones criteria could lead to under-diagnosis in developing countries. The recent AHA 2015 guidelines highlighted a subgroup of “exceptions to Jones Criteria” for patients with chorea, indolent carditis and previous history of rheumatic fever or “rheumatic heart disease.” Such patients may also remain undiagnosed if not properly investigated. Although, the guidelines failed to highlight the role of echocardiography in these subgroups. It is important that suspected population be subjected to echocardiographic screening, as clinical detection of soft murmurs can sometimes be very difficult. Doppler and colour flow mapping is even more sensitive in picking up minor valvular regurgitation. Since in India ARF and RHD continue to be on rampant, we decided to investigate the role of echocardiography in diagnosis of subclinical cases of acute rheumatic fever and rheumatic heart disease in young population of India. MATERIALS AND METHODS A total of 200 patients diagnosed or suspected of RF or RHD attending Outpatient and Inpatient department of LLRH and associated hospitals, GSVM Medical College, Kanpur, were included in the study and subjected to echocardiographic study. RESULTS Out of 200 patients suspected of ARF and RHD, 22 were diagnosed with ARF. Out of 22 ARF patients carditis was diagnosed clinically (on the basis of presence of cardiac murmurs) in 12 of these patients (55%) and on subjecting patients to 2D Echo Doppler all of these 12 patients had evidence of carditis. In addition, another 6 patients were found to have findings suggestive of carditis on 2D Echo Doppler. It had sensitivity in diagnosing carditis to 82%. Also, the specificity and positive predictive value of 2D Echo Doppler were 100% each. CONCLUSION Thus, getting a 2D Echo Doppler done in all the patients suspected of acute rheumatic fever or RHD increased our ability to diagnose cases which were otherwise subclinical in their cardiac symptoms.
Authors and Affiliations
Shri Krishna Gautam, Jitendra Singh Kushwaha, Anjali Verma, Harshit Khare, Brijesh Kumar, Reena Singh
Keywords
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- EP ID EP411314
- DOI 10.14260/jemds/2018/288
- Views 79
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