Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T09:45:36.207Z Has data issue: false hasContentIssue false
  • English
  • Français

The role of echocardiography in diagnosing carditis in the setting of acute rheumatic fever

Published online by Cambridge University Press:  18 November 2005

Ishwarappa B. Vijayalakshmi ,
Jayapal Mithravinda  and
Arale N. Prabhu Deva
Ishwarappa B. Vijayalakshmi
Affiliation:
Children's Heart Care Centre, Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Jayapal Mithravinda
Affiliation:
Children's Heart Care Centre, Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Arale N. Prabhu Deva
Affiliation:
Children's Heart Care Centre, Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Get access Rights & Permissions [Opens in a new window]

Extract

Objectives: Acute rheumatic fever and its sequel, rheumatic heart disease, is a major problem in children, adolescents and young adults. Despite the widespread application of the Jones criterions, carditis is either underdiagnosed or overdiagnosed. Echocardiography is rarely used optimally for precise diagnosis. The objective of our study, therefore, was to define the potential role of echocardiography in detecting carditis in the setting of acute rheumatic fever. Materials and methods: We performed echocardiography in 452 consecutive patients with acute rheumatic fever, clinically diagnosed by the strict Jones criterions, using the patients as part of a multi-centric and double blinded prospective study. Results: Of our 452 patients, 230 were males, and 222 were females. The youngest was aged 1 year 11 months, while the oldest was a 51-year-old female. Out of the 452 cases of acute rheumatic fever, 239 patients (52.8%) had arthritis. Out of 164 cases of clinically diagnosed carditis, only 141 cases had echocardiographic evidence of carditis (85.97%). The remaining 23 patients (14%) had functional murmurs, tachycardia, or anaemia. Of the patients, 2 also had congenitally malformed hearts. Of 40 patients with rheumatic chorea, 28 (70%) had echocardiographic evidence of carditis or valvitis. Polyarthralgia was seen in 213 cases (47.12%), from which only 38 patients (17.8%) had carditis clinically, albeit that 88 patients (41.3%) showed echocardiographic evidence of subclinical carditis or valvitis. Conclusion: Echocardiography, when carried out in patients with acute rheumatic fever diagnosed strictly according to the Jones criterion, can avoid both overdiagnosis and underdiagnosis of carditis. A high incidence of carditis, or subclinical carditis, is detected by echocardiography when performed in patients with rheumatic chorea or arthralgia.

Keywords

Subclinical valvitisJones criterionsrheumatic choreaarthralgia
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 6 , December 2005 , pp. 583 - 588
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Sanyal SK, Thapar MK, Ahmed SH, Hooja V, Tewari P. The initial attack of acute rheumatic fever during childhood in North India; a prospective study of the clinical profile. Circulation 1974; 49: 7–12.Google Scholar
Sanyal SK, Berry AM, Duggal S, Hooja V, Ghosh S. Squeal of the initial attack of acute rheumatic fever in children from North India. A prospective 5-year follow-up study. Circulation 1982; 65: 375–379.Google Scholar
Padmavathi S. Present status of rheumatic fever and rheumatic heart disease in India. Ind Heart J 1995; 47: 395–398.Google Scholar
Padmavathi S. Rheumatic fever and rheumatic heart disease in India at the turn of the Century. Ind Heart J 2002; 53: 35–37.Google Scholar
Hippocrates. The genuine works of Hippocrates (translated from Greek by Francis Adams). Wood, New York, 1986, pp 192–273.
Jones TD. Diagnosis of rheumatic fever. JAMA 1944; 126: 481–484.Google Scholar
Adhoc Committee on Rheumatic Fever and Bacterial Endocarditis of the American Heart Association. Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 1965; 32: 664–668.
Committee on Rheumatic Fever and Bacterial Endocarditis of the American Heart Association. Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 1984; 69: 203A–208A.
American Heart Association guidelines for the diagnosis of rheumatic fever: Jones criteria, 1992 update. JAMA 1992; 268: 2069–2073.
Narula J, Chandrasekhar Y, Rahimtoola S. Diagnosis of active rheumatic carditis. The echoes of change. Circulation 1999; 100: 1576–1581.Google Scholar
Cotrim C, Macedo AJ, Duarte J, Lima M. The echocardiogram in the first attack of rheumatic fever in childhood. Rev Port Cardiol 1994; 13: 563, 581–586.Google Scholar
Wilson NJ, Neutze JM. Echocardiographic diagnosis of sub clinical carditis in acute rheumatic fever. Int J Cardiol 1995; 50: 1–6.Google Scholar
Vasan RS, Shrivastava S, Vijayakumar M, Narang R, Lister BC, Narula J. Echocardiographic evaluation of patients with acute rheumatic fever and rheumatic carditis. Circulation 1996; 94: 73–82.Google Scholar