Role of Echocardiography In Acute Rheumatic Fever Compared With Jones Criteria
Abstract
Introduction: Rheumatic heart disease (RHD), the sequel of acute rheumatic fever (ARF), is a very common cause of cardiovascular mortality and morbidity. RHD results in enormous disease burden translating into huge economic and social losses in India. Classical ARF is still encountered across the country. The diagnosis of RF remains clinical. Echocardiography is a very important diagnostic tool to detect valvular lesions in patients with carditis of acute rheumatic fever. Jones criteria has been modified several times but the role of echocardiography in detecting carditis is not been mentioned in any modifications.
Methods and Material: The study was conducted from November 2007 to October 2009, for duration of 2 years in GSVM medical college, Kanpur. Patients with joint pain (arthritis, arthralgia), chest pain, dyspnoea, palpitation, chorea (involuntary movements), subcutaneous nodule, erhythema marginatum, sore throat, skin infection, recurrent upper respiratory tract infection etc, who visited OPD, health camps, or were admitted in Medicine and Pediatrics department were included in the study. Thus selected patients were undergone detailed history taking, clinical examinations particularly they were evaluated to find out whether they were having symptom/signs of carditis and fulfilling Jones criteria to diagnose Acute Rheumatic fever. The same patients were evaluated with Echocardiography to detect carditis.
Results: 40 patients were diagnosed as acute rheumatic fever based on revised Jones criteria. Only 24 patients showed carditis clinically, but Echocardiography showed 27 patients with evidence of carditis. Ventricular septal defect was also detected in 3 patients, which was wrongly detected as carditis in clinical examination. 21 patients had carditis clinically, but echocardiography diagnosed carditis in 27 patients. (p value <0.05).
Conclusion: Echocardiography plays a very important role in detection of carditis. Echocardiographic confirmation of carditis could be accepted as major criteria.
Downloads
References
2. WHO. Rheumatic fever and rheumatic heart disease: Report of a WHO Expert Consultation. WHO Technical Report Series. vol. 923. Geneva: World Health Organization; 2004. Expert Consultation on Rheumatic Fever and Rheumatic Heart Disease (2001: Geneva, Switzerland).
3. Ramakrishnan S. Echocardiography in acute rheumatic fever. Ann Pediatr Cardiol. 2009 Jan;2(1):61-4. doi: 10.4103/0974-2069.52812.
4. Saxena A. Diagnosis of rheumatic fever: current status of Jones Criteria and role of echocardiography. Indian J Pediatr. 2000 Mar;67(3 Suppl):S11-4. [PubMed]
5. Tubridy-Clark M, Carapetis JR. Subclinical carditis in rheumatic fever: A systematic review. Int J Cardiol. 2007 Jun 25;119(1):54-8. Epub 2006 Oct 10. [PubMed]
6. Vijayalakshmi IB, Vishnuprabhu RO, Chitra N, Rajasri R, Anuradha TV. The efficacy of echocardiographic criterions for the diagnosis of carditis in acute rheumatic fever. Cardiol Young. 2008 Dec;18(6):586-92. doi: 10.1017/S1047951108003107. Epub 2008 Oct 10. [PubMed]
7. Wilson NJ, Morreau J, Voss L, Stewart J, Lennon D. The influence of subclinical carditis on the diagnosis of acute rheumatic fever. Heart Lung Circ. 2005; 14:S1117.
8. Narula J, Chandrasekhar Y, Rahimtoola S. Diagnosis of active rheumatic carditis. The echoes of change. Circulation. 1999 Oct 5;100(14):1576-81. [PubMed]
9. Markowitz M. Evolution and critique of changes in the Jones criteria for the diagnosis of rheumatic fever. N Z Med J. 1988 Jun 8;101(847 Pt 2):392-4. [PubMed]
10. Narula J, Reddy KS, Khaw BA. Can antimyosin scintigraphy supplement the Jones Criteria in the diagnosis of active rheumatic carditis? In: Khaw BA, Narula J, Strauss HW, eds. Monoclonal Antibodies in Cardiovascular Diseases. Philadelphia, Pa: Lea & Febiger; 1994. [PubMed]
11. Narula J, Chopra P, Talwar KK, Vasan RS, Reddy KS, Tandon R, Bhatia ML, Southern JF. Endomyocardial biopsies in acute rheumatic fever. Circulation. 1993 Nov;88(5 Pt 1):2198-205. [PubMed]
12. Bhatnagar A, Calegaro JUM, Narula J. Radionuclide imaging in acute rheumatic fever. In: Narula J, Virmani R, Reddy KS, Tandon R, eds. Rheumatic Fever. Washington, DC: American Registry of Pathology Publication; 1999:329–338.
13. Feinstein AR, Stern EK, Spagnuolo M. The prognosis of acute rheumatic fever. Am Heart J. 1964 Dec;68:817-34. [PubMed]
14. Abernathy M, Bass N, Sharpe N, Grant C, Neutze J, Clarkson P, Greaves S, Lennon D, Snow S, Whally G. Doppler echocardiography and the early diagnosis of carditis in acute rheumatic fever. Aust N Z J Med. 1994 Oct;24(5):530-5. [PubMed]
15. Vijayalakshmi IB, Mithravinda J, Deva AN. The role of echocardiography in diagnosing carditis in the setting of acute rheumatic fever. Cardiol Young. 2005 Dec;15(6):583-8. [PubMed]
16. IB Vijayalakshmi. Rheumatic Fever, Rheumatic Heart Disease Registry and Control Program. IB Vijayalakshmi ed. Acute Rheumatic Fever and Chronic Rheumatic Heart disease. 2011. Jaypee Brothers Medical Publishers. India. P324-336.
17. Carapetis JR, Brown A, Wilson NJ, Edwards KN. Rheumatic Fever Guidelines Writing Group. An Australian guideline for rheumatic fever and rheumatic heart disease: An abridged outline. Med J Aust. 2007 Jun 4;186(11):581-6.
18. Atatoa-Carr P, Lennon D, Wilson N. New Zealand Rheumatic Fever Guidelines Writing Group. Rheumatic fever diagnosis, management, and secondary prevention: A New Zealand guideline. N Z Med J. 2008 Apr 4;121(1271):59-69.
OAI - Open Archives Initiative
