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Presentation of rheumatic heart disease in a specialist clinic in sudan

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1586, oral, cat: 58


A. Karrar, R. Al-Khalifa, I. Ali

Dept. of Cardiology, Ahmed Gasim Hospital, Khartoum, Sudan

Introduction: Rheumatic heart disease causes significant morbidity and mortality, especially in developing countries. It is caused by an inappropriate immune response as a result of cross reactivity of antibodies against streptococcus antigens with human antigens. Effective treatment of tonsillitis with antibiotics reduces the risks of developing rheumatic fever significantly.

Methods: This was a prospective study carried out in a specialist clinic in Ahmed Gasim Hospital in Khartoum between 01/09/2004 to 01/11/2004 and all attendees were diagnosed with rheumatic heart disease and included without exclusion. Information regarding their presentation, background, valvular involvement and any evidence of heart failure were taken.

Results: 50 patients were reviewed; age (5 to 40 years), and female to male ratio 3:1. History of tonsillitis was present in 31(62%), and patients from rural backgrounds represented 69%. Evidence of heart failure was present in 37 (74%). Isolated mitral stenosis was seen in 14%, mitral regurgitation in 12% and mixed mitral disease in 28%. Isolated aortic valve was seen in only 6% of which 4% stenosis and 2% regurgitation. Multiple valvular involvement was present in 40% of the patients divided to; mitral and aortic valves 30%, mitral and tricuspid 8%, and mitral and pulmonary 2%. Echo cardio-graphic evidence was available for 88% of patients and severe valvular lesions were reported in 35%.

Conclusion: There was higher incidence of the disease amongst females and those from rural areas. The high frequency of heart failure, multiple valvular involvement and severe valvular lesions mean that preventative antibiotic therapy and increasing awareness of the condition are paramount to a cost effective solution.

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