Clinical and Echocardiographic Features of Rheumatic Heart Disease at First Presentation at a Tertiary Care Setup

Objective: To find out the mode of presentation and severity of cardiac involvement in children presented with established rheumatic heart diseases (RHD) at first presentation at a tertiary care setup. Study Design: Cross-sectional study. Place and Duration of the Study: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease, Karachi Pakistan, from Jul 2020 to Jun 2021. Methodology: One hundred seven children of genders aged 3 to 18 with a confirmed diagnosis of RHD were included. Demographic features, chief presenting complaints, possible reasons for late presentation, and echocardiographic findings were noted. Results: In 107 patients with RHD, 63(58.9%) were male. The sensation of the rapid pounding of heartbeat (palpitation) was observed among 72(67.3%) children, while a similar number of cases, 72(67.3%), presented with breathlessness. There were 33(30.8%) children who were diagnosed for the first time with RHD. The most common reason for late diagnosis was socioeconomic factors in children (18, 26.1%). Primary prophylaxis for acute rheumatic fever (ARF)/RHD was noted to be given in 11(10.3%) patients. Mitral regurgitation was the most common echocardiographic finding in 103(96.3%), followed by aortic regurgitation in 99(92.5%). Conclusion: The majority of children with RHD are diagnosed late, which exposes them to an increased risk of undiagnosed valvular disorders. Palpitation, orthopnea and breathlessness were RHD most frequent presenting clinical features. Mitral regurgitation and aortic regurgitation were the most common echocardiographic findings.