Background In spite of rarity in many areas, acute rheumatic fever (ARF) continues to be one of the most causes of valvular heart disease in the developing countries.
Persistence of residual heart disease depends on the severity of carditis at the time of acute attack and the frequency of subsequent recurrences.
Objectives To determine the frequency and the outcome of carditis in ARF, medical records of patients with ARF diagnosed in Shaheed Beheshti hospital from 1985–1990 were reviewed.
Methods All admitted and referral patients satisfying the modified Jones criteria for the diagnosis of ARF with follow up period over than one year included the study.
Diagnosis of carditis was based on physical findings and auscultation. Presence of residual heart disease was confirmed by clinical exminations during the follow up period and at the time of the last visit. In a few patients echocardiography was performed to document the valvular lesion.
Results 38 (19 Male, 19 female) patients with median age of 14.5 years (range 5–36) were studied. All patients presented with polyarthritis. Carditis occured in 14 (37%) patients. Mitral regurgitation alone in 10, and in combination with aortic regurgitation and stenosis in 2, aortic stenosis and regurgitation alone in 2.
Secondary prophylaxis (SP) was recommended and patients were followed for a mean period of 6 (range 1–15) years.
No recurrences were seen in 22 (56%) patients who remained on SP, whereas 6 of 16 noncompliants with SP showed recurrences. five attacks of recurrences observed in 6 noncompliant patients with carditis.
Among the 14 patients with carditis, residual valvular disease persisted in all 5 cases of carditis who had recurrences and 3 of 9 patients without recurrence.
Conclusion RF remains a significant health problem in the developing countries and disease recurrence is an important risk factor for persistence of residual heart disease, so strict adherence to SP is indicated
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