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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
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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

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