Electrocardiographic Digital Biomarkers in Asymptomatic Schoolchildren with Rheumatic Heart Disease

The detailed analysis of the P-wave duration and dispersion by means of conventional electrocardiography with the 12 standard surface leads in the stratification of patients suffering from AF is a recognized universal approach. P-wave dispersion (PWD) has received increasing attention in the field of non-invasive electrophysiology studying atrial arrhythmias and has been examined in a broad range of clinical settings including cardiovascular and non-cardiovascular diseases. It is well accepted that, not only the P-wave duration, but also the P-wave morphology and dispersion have the potential to give information about the anatomical substrate predisposing to AF. Patients with diseased atrial myocardium with fibrotic changes may develop abnormal electrophysiological alterations. Therefore, these atrial anisotropic characteristics may play an important role in creating reentry circuits by causing inhomogeneous and discontinuous propagation of the impulse in the atrial tissue. The altered atrial myocardium may generate unidirectional block, conduction delay and reentrant atrial rhythms. The P-wave of the electrocardiogram may show alterations that can be associated with atrial arrhythmias and AF. PWD is considered a noninvasive electrocardiographic marker for atrial remodeling and predictor for AF. It has been shown that increased P-wave duration and PWD reflect prolongation of intra-atrial and inter-atrial conduction time. In patients prone to develop atrial arrhythmias and AF, PWD reflects prolonged, inhomogeneous and anisotropic distribution of connections between myocardial fibers resulting in discontinuous anisotropic propagation of sinus impulses and atrial conduction. PWD is considered as a sensitive and specific ECG marker and predictor of atrial arrhythmias and paroxysmal AF.

Excerpt Although many careful studies have been made of rheumatic heart disease throughout the world, many misconceptions of the etiologic factors of the disease still exist. If one studies the rep...

Simple electrocardiogram (ECG) markers have been used to evaluate conduction times. Acute rheumatic fever (ARF) is an autoimmune disease that affects these conduction times. The aim of this prospective long-term follow-up study was to evaluate QT, QTc and P-wave dispersions in children with ARF and chronic rheumatic heart disease (CRHD). Sixty-four patients with ARF, 33 patients with CRHD and 41 healthy, age- and sex-matched control subjects were included in the study. The ARF patients were divided into two subgroups: carditis and arthritis. Echocardiographic and ECG measurements at the onset of diagnosis and final evaluation were included. QT, QTc and P-wave dispersions were significantly greater in both the ARF carditis and CRHD groups than the ARF arthritis and control subjects during the initial and final analysis (for all, P < 0.001). There was no significant statistical difference in QT, QTc and P-wave dispersion between the initial and final analysis in each groups. Severity of mitral regurgitation and left atrial enlargement were found to be positively correlated with P-wave dispersion (r = 0.438, P < 0.001; r = 0.127, P < 0.001, respectively). QT, QTc and P-wave dispersion greater than 52, 60 and 57 ms, respectively, had higher sensitivity and specificity for predicting ARF carditis. These ECG measurements can be used in the diagnosis of ARF carditis as minor criteria with modified Jones criteria. In contrast, this increase in the dispersions is permanent in patients with ARF carditis.

While the incidence and importance of acute rheumatic fever has been declining in industrialized countries it remains as the most important cause of acquired heart disease in developing or undeveloped countries About 3 to 6 of any population is considered to be susceptible to rheumatic fever Although it is common between the ages of 5 and 15 the patients under five years comprise 3 5 of the total number Acute rheumatic fever is diagnosed using the Jones criteria updated by the World Health Organization in 2003 During the first attack two major or one major two minor manifestations in the presence of evidence of recent streptococcal throat infection is a high probability of rheumatic fever Major manifestations are migratory polyarthritis carditis chorea erythema marginatum and subcutaneous nodules; minor manifestations are fever over 38oC arthralgia elevated acute phase reactants ESR gt;60mm hr C reactive protein and prolongation of PR interval on electrocardiogram Positive throat culture for streptococci elevated increasing ASO titers and history of scarlet fever are accepted as evidences of recent streptococcal infection The role of echocardiography has increased in recent years When echocardiography is not performed subclinical valvular involvements are not recognized and these patients may present with rheumatic heart disease in the future Bed chair rest antibiotic treatment anti inflammatory treatment the treatment for congestive heart failure and sedation in patients with chorea are options for management of rheumatic fever The only intervention proven to affect long term prognosis is secondary prophylaxis In conclusion rheumatic fever may present in various appearances and still bites the heart Turk Arch Ped 2007; 42: 85 93 Key words: Acute rheumatic fever rheumatic heart disease Jones criteria

Introduction: Rheumatic fever and rheumatic heart disease is a common problem in developing countries. Rheumatic valvular heart disease is one of the important risk factor for infective endocarditis. Methods: Retrospective study was conducted among 56 children admitted in cardiology ward of Kanti children hospital with the diagnosis of rheumatic fever or rheumatic heart disease during May 2008 to M ay 2010. Results: We found male to female ratio 2: 1, median age 12 (5- 14yrs) with the most affected age group of 11- 12 years. Common symptoms were fever (66%), dyspnea (68%), joint pain (50%), palpitation (30%), cough (16%) and chest pain (12%). Only 9% of patients had positive history of sore throat. Six ty percent patients were presented with features of congestive cardiac failure (CCF). A SO positive was found in 25 (44.6%) cases. The most common valvular lesion was mitral regurgitation (M R). Moderate to severe mitral regurgitation was found in 89% of cases. Tricuspid regurgitation (T R) was found in 57% of patients and aortic regurgitation (A R) in 55% of cases. Thirty-two patients (57%} had PA H in which 8 patients has severe PAH and 24 patients had mild to moderate PAH . Infective endocarditis was diagnosed in twenty patients (35.7%). Out of 20 patients 14 (70%) had vegetation in echocardiography. The mortality was 11% in this study. Conclusion: Infective endocarditis is the major complication of rheumatic heart disease among children of Nepal and so clinical suspecian is important whenever patients with rheumatic heart disease present with fever.

Article1 August 1943THE INCIDENCE OF ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS IN RHEUMATIC HEART DISEASERAYMOND GELFMAN, M.D.RAYMOND GELFMAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-19-2-253 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIt is well known that the possibility of developing acute or subacute bacterial endocarditis constitutes a decided threat to the patient with rheumatic disease.1, 2, 3, 4, 5, 6, 7 Fully 20 to 25 per cent of all patients whose hearts have been the site of preëxisting rheumatic activity are said to fall prey to the ravages of infectious endocarditis. Moreover, 90 per cent or more of all bacterial endocarditis is found in hearts that have been previously damaged by the rheumatic infection.5Believing that it might prove profitable to inquire once again into the incidence of superimposed infectious processes...Bibliography1. BLUMER G: Subacute bacterial endocarditis, Medicine, 1923, ii, 105. CrossrefGoogle Scholar2. FULTONLEVINE MNSA: Subacute bacterial endocarditis, with special reference to valvular lesions and previous history, Am. Jr. Med. Sci., 1932, clxxxiii, 60. CrossrefGoogle Scholar3. DAVISWEISS DS: The relation of subacute and acute bacterial endocarditis to rheumatic endocarditis, New England Jr. Med., 1933, xii, 619. CrossrefGoogle Scholar4. KEEFER C: The pathogenesis of bacterial endocarditis, Am. Heart Jr., 1940, xix, 352. CrossrefGoogle Scholar5. CHRISTIAN HA: The determinative background of subacute bacterial endocarditis, Am. Jr. Med. Sci., 1941, cci, 34. Google Scholar6. LAWSLEVINE CLSA: Clinical notes on rheumatic heart disease with special reference to the cause of death, Am. Jr. Med. Sci., 1933, clxxxvi, 833. CrossrefGoogle Scholar7. HEDLEY OF: Rheumatic heart disease in Philadelphia hospitals, Pub. Health Rep., 1940, lv, 1707. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachusetts*Received for publication March 12, 1942.From the Medical clinic of the Peter Bent Brigham Hospital, Boston. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byBACTERIAL ENDOCARDITIS IN A SYDNEY HOSPITAL FROM 1960 TO 1965Infective Endocarditis in the Antibiotic EraChronic Rheumatic Valvular Heart Disease in IcelandDie Herz- und GefäßkrankheitenBACTERIAL ENDOCARDITIS IN THE AGED*JACQUES B. WALLACH, M.D., MACELLIS GLASS, B.A., LESLIE LUKASH, M.D., ALFRED A. ANGRIST, M.D.Mitral Valve Disease over the Age of 50STUDIES ON THE AGING HEART. I. THE PATTERN OF RHEUMATIC HEART DISEASE IN OLD AGE (A CLINICAL-PATHOLOGICAL STUDY)*PAUL KAUFMAN, M.D., F.A.C.P., HARVEY POLIAKOFF, M.D.Bacterial Endocarditis in the ElderlyMITRAL STENOSIS IN LATER LIFESubacute bacterial endocarditis in the aged 1 August 1943Volume 19, Issue 2Page: 253-255KeywordsBacterial diseasesBacterial physiologyCardiovascular therapyChildrenEndocarditisFallsHeartHospitalsInfantsInfectious diseases ePublished: 1 December 2008 Issue Published: 1 August 1943 PDF downloadLoading ...

Background Rheumatic fever has a marked tendency to recur leading to high risk of chronic heart lesions or worsening lesions in patients with previous rheumatic heart disease. For secondary prevention of RF, long acting penicillin can be used. Some rheumatic heart disease patients suffer from atrial fibrillation. Cardiac rhythm may affect the response of the body to the long acting penicillin, so it would be helpful to study the effect of cardiac rhythm on serum levels of inflammatory mediators in patients with chronic rheumatic heart disease. Objectives Our study is a prospective cross-sectional controlled study that aims to study the effect of cardiac rhythm on serum levels of the inflammatory mediators; C-Reactive Protein and Interleukin-6 in patients with chronic rheumatic heart disease. Methods The study included 70 rheumatic heart disease patients on regular long acting penicillin. Patients were divided into to 2 groups: Group A; 56 patients with rheumatic heart disease who have sinus rhythm, and Group B; 14 patients with rheumatic heart disease who have atrial fibrillation (AF) and Group C; control group of 10 healthy individuals. Results There was no significant difference between sinus patients and AF patients in CRP and IL-6 levels (p = 0.3050 and 0.6758, respectively). Also, there was no significant difference between 15, 21 and 30 days regimens of penicillin in CRP and IL-6 levels (p = 0.9467and 0.0795, respectively). IL6 values were significantly correlated with CRP values (r = 0.5435, p &amp;lt; 0.0001). There was a significant difference in CRP and IL-6 levels between compliant and non-compliant patients (p = 0.0053 and 0.0308). Conclusion Our study results disprove that cardiac rhythm has an effect on the serum levels of the inflammatory mediators C-Reactive Protein and Interleukin-6 in chronic rheumatic heart disease. Our study also disproves the preference of any regimen of long acting penicillin (15 days, 21 days and 30 days) over each other for secondary prevention of chronic rheumatic heart disease. Our study results emphasized that chronic rheumatic heart disease is an inflammatory process mediated with some mediators as CRP and IL-6 that are strongly correlated with each other.

Augmented sympathoadrenal activity during exercise may contribute to occurrence of various arrhythmias including atrial fibrillation (AF). The prolongation of intraatrial and interatrial conduction times and inhomogeneous propagation of sinus impulses are well-known characteristics of the atrium prone to fibrillate and are evaluated by maximum P-wave duration (P max), P-wave dispersion (PWD). To show the increased P max and PWD values in patients experiencing AF during exercise testing and the role of beta blockade on treatment of exercise-induced AF, 22 of these patients were compared with a control group consisting of 41 patients without AF attacks. P max (p = 0.001) and PWD (p = 0.001) values were significantly higher in patients with AF compared to those without AF. The development of AF during exercise testing was found to be positively correlated with P max (r = 0.87, p < 0.001), PWD (r = 0.83, p = 0.001), and work load (r = 0.34, p = 0.002) and negatively correlated with ejection fraction (r = -0.26, p=0.02). After the treatment with beta-blocking agents for 2 weeks, the decrease in P max and PWD values was accompanied by a much lower prevalence of exercise-induced AF. Consequently, the patients with AF had greater P max and PWD values compared to control subjects, and these simple parameters were well correlated with the occurrence of AF during exercise testing. Furthermore, treatment of these patients with beta blockers would appear to decrease the recurrence of exercise-induced AF and to be associated with a decrease in P-wave durations.

Acute rheumatic fever (ARF) is a sequela of streptococcal infection—typically following 2 to 3 weeks after group A streptococcal pharyngitis—that occurs most commonly in children and has rheumatologic, cardiac, and neurologic manifestations. Rheumatic heart disease (RHD) refers to the long-term cardiac damage caused by either a single severe episode or multiple recurrent episodes of ARF. Secondary prophylaxis with regular intramuscular injections of benzathine penicillin G (BPG) is a key component to prevent ARF and RHD recurrent. This study aimed to evaluate the secondary prophylaxis effectiveness based on the profile of clinical manifestations and blood laboratory findings. The data were collected by interviews, complete blood counts, the anti-streptolysin titer O (ASTO) analysis, the C-reactive protein Assay, electrocardiography, and echocardiography. Data were analyzed using SPSS 18, and the results were presented as the percentage frequency. The samples were 63 patients with ARF and RHD who get secondary prophylaxis, consisting of 32 males (50.8%) and 31 females (49.9%). The echocardiography examination showed that valve regurgitation was more common than valve stenosis, indicating longer P-R interval in 49 subjects (77.7%). Sixty subjects (92.2%) received secondary prophylaxis with BPG injection, and three subjects (4.8%) got Erythromycin oral. The main factor of secondary prophylaxis adherence is pain and injection disliking. How to Cite this Article Pubmed Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. 2020; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Web Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. http://www.sysrevpharm.org/?mno=11016 [Access: March 29, 2021]. doi:10.31838/srp.2020.9.63 AMA (American Medical Association) Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. 2020; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Vancouver/ICMJE Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. (2020), [cited March 29, 2021]; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Harvard Style DIMIATI, H., SOFIA, . S. & GANI, . B. A. (2020) for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP, 11 (9), 452-457. doi:10.31838/srp.2020.9.63 Turabian Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. 2020. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Reviews in Pharmacy, 11 (9), 452-457. doi:10.31838/srp.2020.9.63 Chicago Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. Systematic Reviews in Pharmacy 11 (2020), 452-457. doi:10.31838/srp.2020.9.63 MLA (The Modern Language Association) Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. Systematic Reviews in Pharmacy 11.9 (2020), 452-457. Print. doi:10.31838/srp.2020.9.63 APA (American Psychological Association) Style DIMIATI, H., SOFIA, . S. & GANI, . B. A. (2020) for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Reviews in Pharmacy, 11 (9), 452-457. doi:10.31838/srp.2020.9.63

Introduction: Congestive cardiac failure is the failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissue and or its ability to do so requires an abnormally elevated pressure. CCF once sets in, pressure with malignant progression with one year mortality of 38% and 15% and six year mortality of 80% and 65% in men and women respectively. Acute rheumatic fever(ARF) and its sequel Rheumatic Heart Disease(RHD) may impair myocardial function to precipitate failure. Aim: To study clinical features of Congestive Cardiac Failure in Rheumatic Heart Disease. Methods: A prospective study with 50 patients admitted between August 2006 and September 2008 in Shree Birendra Hospital formed the subject of this study.Patients of rheumatic valvular heart disease of both sexes in congestive cardiac failure at the time of admission or who developed failure during hospitalization were taken into the study. Detailed history was taken from all patients. Detailed examination was done in all patients with emphasis in cardiovascular and relevant system. Modified Framingham heart study criteria was used for the diagnosis of CCF. Results: A total of 50 patients with RHD in CCF were the subject of study. The average age was 33.78 years. The presenting clinical features of the patients were breathlessness on exertion and it was the commonest presenting complaint and was present in all patients. Palpitation was present 37 of 50 patients(74%). Basal crepitation was the commonest clinical sign present and 29 of 50 patients(58%) had the raised jugular venous pressure. Mitral valve was the commonest valve involved (with/without) other valves) and was seen in 94% (47) patients. Key words: Congestive Cardiac Failure; Rheumatic Heart Disease DOI: http://dx.doi.org/10.3126/mjsbh.v9i2.5019 Medical Journal of Shree Birendra Hospital Vol.9(2) 2010: 8-12

"Dally, John Frederick Halls, (died 4 Nov. 1944), Consulting Physician to Mount Vernon Hospital; Senior Physician to St Marylebone and Western General Dispensary and Director of the Children’s Supervisory Centre for Rheumatism and Rheumatic Heart Disease; Medical Supt Bromsgrove Emergency Hospital, Worcestershire; Consulting Physician to Sutton War Emergency Hospital, to Philanthropic Society’s School, Redhill and to the Shriners Hospital, Montreal; Editor, West London Journal; Vice-President Chelsea Clinical Society; Member of St Marylebone War Committee; late Chairman, Special Neurological Board of Ministry of Pensions" published on by Oxford University Press.

Cardiologists’ perception of the risk of stroke in rheumatic heart disease (RHD) is influenced more by anecdote and opinion than by the evidence.1 Despite data indicating a similar, if not...

Acute rheumatic fever and rheumatic heart disease are major causes of morbidity and mortality in developing countries. Genetic studies have determined that the immune response in rheumatic heart disease is genetically controlled and that there is a close relationship between the gene of concern and the class II human leukocyte antigen (HLA) gene. The aim of this study was to evaluate the relationship of serum HLA-B alleles and tumor necrosis factor alpha (TNF-α) with rheumatic heart disease. A total of 50 consecutive patients with rheumatic heart disease and 50 controls were enrolled in the study. HLA alleles were analyzed using sequence-specific primer-polymerase chain reaction and nucleotide sequencing. The HLA-B35 allele was significantly more common in patients with rheumatic heart disease than the control group (P = 0.043). The HLA-B44 allele was significantly more common in control patients than in patients with rheumatic heart disease (P = 0.014). There was a significant inverse correlation between high-sensitivity C-reactive protein and mitral valve area (P = 0.001). There was no correlation between TNF-α levels and mitral valve area (P = 0.066). Our findings confirmed the association between HLA-B alleles and rheumatic heart disease.

Identification of patients with latent rheumatic heart disease by echocardiography presents a unique opportunity to prevent disease progression. Myocardial strain is a more sensitive indicator of cardiac performance than traditional measures of systolic function. The objective of this study was to test the hypothesis that abnormalities in myocardial strain may be present in children with latent rheumatic heart disease. Standard echocardiography images with electrocardiogram gating were obtained from Ugandan children found to have latent rheumatic heart disease as well as control subjects. Traditional echocardiography measures of systolic function were obtained, and offline global longitudinal strain analysis was performed. Comparison between groups was performed using strain as a continuous (Mann-Whitney U-test) and categorical (cut-off 5th percentile for age) variable. Our study included 14 subjects with definite rheumatic heart disease, 13 with borderline rheumatic heart disease, and 112 control subjects. None of the subjects had abnormal left ventricular size or ejection fraction. Global longitudinal strain was lower than the 5th percentile in 44% of the subjects with any rheumatic heart disease (p=0.002 versus controls) and 57% of the subjects with definite rheumatic heart disease (p=0.03). The mean absolute strain values were significantly lower when comparing subjects with any rheumatic heart disease with controls (20.4±3.95 versus 22.4±4.35, p=0.025) and subjects with definite rheumatic heart disease with controls (19.9±4.25 versus 22.4±4.35, p=0.033). Global longitudinal strain is decreased in subjects with rheumatic heart disease in the absence of abnormal systolic function. Larger studies with longer-term follow-up are required to determine whether there is a role for strain to help better understand the pathophysiology of latent rheumatic heart disease.

Background: Transplanted patients are frail individuals who may be affected by diastolic dysfunction, leading to a decrease in exercise tolerance. Previous studies have reported that certain ECG and echocardiographic parameters (such as the P-wave interval, PQ interval, P-wave dispersion, Tend-P interval, QTc interval, and strain) can support the diagnosis of diastolic dysfunction when the ejection fraction is preserved. This study aimed to examine the potential diagnostic contribution of specific ECG and deformation parameters in transplanted recipients, who are at a high risk of heart failure. Materials and Methods: A group of 33 transplanted subjects (17 renal and 16 liver) were categorized using two scores for heart failure with preserved ejection fraction (HFpEF). Additionally, they underwent evaluation based on ECG parameters (P-wave interval, PQ interval, Pwave dispersion, and Tend-P QTc) and echocardiographic deformation parameters (strain and twist). The Student’s t-test was used for statistical analysis. Results: The two scores identified different numbers of excludable and not excludable subjects potentially affected by HFpEF. The not excludable group presented ECG parameters with significantly higher values (P-wave, PQ interval, posterior wall diastole, and Tend-P, all with p ≤ 0.05) and significantly lower 4D strain and twist values (p &lt; 0.05) Conclusions: There is evidence for a significant diagnostic contribution of additional ECG and echo strain parameters in an early phase of diastolic dysfunction in subjects potentially affected by HFpEF.