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%).
