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| ==Screening== | | ==Screening== |
| Rheumatic fever is a delayed sequel to upper respiratory track infection by [[Group A streptococcus]], which can lead to immunologic damage of heart and heart valves. Rheumatic heart disease usually results from the repeated damage by recurrent episodes of acute rheumatic fever. [[Cardiac auscultation]] becomes unremarkable in one-third of children after a first episode of [[carditis]]. But even these children may progress to significant valvular disease, as confirmed by [[echocardiography]].<ref name="pmid16020588">{{cite journal| author=Meira ZM, Goulart EM, Colosimo EA, Mota CC| title=Long term follow up of rheumatic fever and predictors of severe rheumatic valvar disease in Brazilian children and adolescents. | journal=Heart | year= 2005 | volume= 91 | issue= 8 | pages= 1019-22 | pmid=16020588 | doi=10.1136/hrt.2004.042762 | pmc=PMC1769032 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16020588 }} </ref> Therefore early detection of subclinical disease process helps in early treatment and improves prognosis by preventing recurrence.<ref name="pmid18297157">{{cite journal| author=Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Sidi D et al.| title=Echocardiographic screening for rheumatic heart disease. | journal=Bull World Health Organ | year= 2008 | volume= 86 | issue= 2 | pages= 84 | pmid=18297157 | doi= | pmc=PMC2647380 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18297157 }} </ref>
| | According to the World Health Organization, screening for rheumatic fever by [[echocardiogram]] is recommended among patients with from high risk communities with abnormal auscultatory findings. Early detection of subclinical disease process helps in early treatment and improves prognosis by preventing recurrence.<ref name="pmid18297157">{{cite journal| author=Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Sidi D et al.| title=Echocardiographic screening for rheumatic heart disease. | journal=Bull World Health Organ | year= 2008 | volume= 86 | issue= 2 | pages= 84 | pmid=18297157 | doi= | pmc=PMC2647380 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18297157 }} </ref> Screening is performed to prevent significant valvular disease.<ref name="pmid16020588">{{cite journal| author=Meira ZM, Goulart EM, Colosimo EA, Mota CC| title=Long term follow up of rheumatic fever and predictors of severe rheumatic valvar disease in Brazilian children and adolescents. | journal=Heart | year= 2005 | volume= 91 | issue= 8 | pages= 1019-22 | pmid=16020588 | doi=10.1136/hrt.2004.042762 | pmc=PMC1769032 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16020588 }} </ref> |
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| Screening of rheumatic heart disease involves: | | Screening of rheumatic heart disease involves: |
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| #Cardiac auscultation for [[murmur]]s | | #Cardiac auscultation for [[murmur]]s |
| #[[Echocardiography]] | | #[[Echocardiography]] |
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| Evidence of valve abnormalities with a history of rheumatic fever is suggestive of rheumatic heart disease. Previously, individuals from high risk communities with abnormal auscultatory findings were subjected for further evaluation with echocardiography. But studies relying on echocardiography in the diagnosis of RHD have demonstrated that rates of subclinical carditis is up to 10 times higher than that diagnosed by clinical examination. The current screening approach involves screening of all individuals in high risk communities with portable echocardiography.<ref name="pmid17671255">{{cite journal| author=Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D et al.| title=Prevalence of rheumatic heart disease detected by echocardiographic screening. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 5 | pages= 470-6 | pmid=17671255 | doi=10.1056/NEJMoa065085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17671255 }} </ref><ref name="pmid20345448">{{cite journal| author=Bhaya M, Panwar S, Beniwal R, Panwar RB| title=High prevalence of rheumatic heart disease detected by echocardiography in school children. | journal=Echocardiography | year= 2010 | volume= 27 | issue= 4 | pages= 448-53 | pmid=20345448 | doi=10.1111/j.1540-8175.2009.01055.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20345448 }} </ref><ref name="pmid18952636">{{cite journal| author=Sadiq M, Islam K, Abid R, Latif F, Rehman AU, Waheed A et al.| title=Prevalence of rheumatic heart disease in school children of urban Lahore. | journal=Heart | year= 2009 | volume= 95 | issue= 5 | pages= 353-7 | pmid=18952636 | doi=10.1136/hrt.2008.143982 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18952636 }} </ref><ref name="pmid18398402">{{cite journal| author=Carapetis JR, Hardy M, Fakakovikaetau T, Taib R, Wilkinson L, Penny DJ et al.| title=Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren. | journal=Nat Clin Pract Cardiovasc Med | year= 2008 | volume= 5 | issue= 7 | pages= 411-7 | pmid=18398402 | doi=10.1038/ncpcardio1185 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18398402 }} </ref>
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| The World Heath Organization recommends [[antibiotic]] prophylaxis should be administered to patients with echocardiographically detected significant subclinical rheumatic heart disease, characterized by a "very mild regurgitant jet, more than 1.0 cm, localized immediately above or below the valve, throughout systole at the [[mitral valve]] or diastole at the [[aortic valve]]."<ref>[http://www.who.int/cardiovascular_diseases/resources/en/cvd_trs923.pdf Rheumatic fever and rheumatic heart disease: report of a WHO Expert Consultation, Geneva, 29 October–1 November 2001. Geneva: WHO, 2004]</ref> This criteria was found to be inadequate as it did not include valves with morphological features of rheumatic heart disease without pathological regurgitation.
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| ==References== | | ==References== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. [2]; Anthony Gallo, B.S. [3]
Overview
Screening of rheumatic fever is important as many cases of rheumatic heart disease are subclinical. Echocardiography among inhabitants of high risk regions is recommended. If any abnormality is detected on echocardiography, further cardiac evaluation is performed followed by antimicrobial therapy.[1]
Screening
According to the World Health Organization, screening for rheumatic fever by echocardiogram is recommended among patients with from high risk communities with abnormal auscultatory findings. Early detection of subclinical disease process helps in early treatment and improves prognosis by preventing recurrence.[1] Screening is performed to prevent significant valvular disease.[2]
Screening of rheumatic heart disease involves:
- Eliciting history of rheumatic fever
- Cardiac auscultation for murmurs
- Echocardiography
References
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