Clinical and echocardiographic profile of paediatric patients with rheumatic heart disease at Moi Teaching and Referral Hospital

Abstract

Background: Rheumatic heart disease (RHD) is the commonest acquired heart disease and a major cause of morbidity and mortality among children in developing countries. Clinical features alone are inadequate in the diagnosis of specific valvular heart lesion even with a well-trained physician. While echocardiographic studies are capable of diagnosing valvular lesions, they are not readily available for those who require them the most. A combination of both a clinical and echocardiographic diagnosis is important to make a proper and early diagnosis. Objective: To determine the clinical and echocardiographic profile of paediatric patients with RHD at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methodology: This was a cross sectional study carried out between October 2009 and October 2010 in the general peadiatric wards, paediatric outpatient clinic and cardiology clinic at the MTRH. The study subjects were children with RHD aged 3 to 15 years, who met the inclusion criteria. Consecutive sampling was done. Data was collected in a structured questionnaire and analyzed using Genstat discovery. Results: Eighty four children with RHD were enrolled. Of these, 46(54.76%) were new patients and 38(45.23%) were on secondary prophylaxis. There were 28 male and 56 female. The median age was 11 yrs. (3.5, 15).The commonest symptoms among the new patients included; dyspnea(84.78%), easy fatigability (82.61%), palpitations (73.91%),cough(69.57%) and orthopnea (63.04%), while the signs were systolic murmur (89.13%), thrill (78.26%) and tachycardia (76.09%).Six (13.04%) new patients were asymptomatic at presentation. Sixty nine percent of the new patients were in NYHA class 3 and 4. Nine of the patients on follow up (23.68%) were non-compliant to secondary prophylaxis. The commonest lesion was isolated mitral regurgitation 39(46.43%), followed by mitral regurgitation + aortic regurgitation 30(35.71%) then mitral regurgitation + mitral stenosis 5(5.95%).Mitral regurgitation and mitral stenosis alone or in combination were present in 94.04% and 14(16.67%) of the patients respectively. Most new patients had severe valvular lesion at the time of presentation. Complications observed include pulmonary hypertension (52.38%), functional tricuspid regurgitation (47.62%) and left ventricular systolic dysfunction (10.71%).