Decline In Rheumatic Heart Disease Research Articles

Changing Spectrum of Cardiac Diseases in Children: An Extended Longitudinal Observation Study of a Pediatric Cardiac Screening Program.

The spectrum of cardiac diseases in children is distinct from that in adults, and changes with advances in medical care and socioeconomic conditions. Such data are important for the allocation of medical resources, but are unclear. Based on a longitudinal pediatric cardiac screening program, we sought to delineate the spectrum and the trends. From 2002 to 2018, citywide screening programs of cardiac diseases for children were performed in Taipei, Taiwan. Participants, mainly students entering the first grade of elementary school, were evaluated using questionnaires, simplified 4-lead electrocardiography (EKG), phonocardiography, and physical examinations. Those suspected of having abnormal cardiac lesions received detailed evaluations by pediatric cardiologists for a final diagnosis. The median prevalence of cardiac lesions in the children was 19.60/1000 (range from 14.9 to 24.65/1000), including congenital heart disease (32.02%), EKG abnormalities (33.34%), mitral valve prolapse (15.17%), Kawasaki disease (6.89%), rheumatic heart disease (0.17%) and others (12.41%). A significant time trend was only observed in a trend of decline in rheumatic heart disease. The median prevalence rates of congenital heart disease, Kawasaki disease, rheumatic heart disease, mitral valve prolapse, and EKG abnormalities were 6.20, 1.37, 0, 3.12, and 6.46 per 1000 children, respectively. This study, based on a citywide cardiac screening program, indicates that the spectrum of cardiac diseases in children has not changed in recent decades, except for a decline or disappearance of rheumatic heart disease in the Taipei metropolitan area. While congenital heart disease and EKG abnormalities were the most common, Kawasaki disease was the most commonly acquired heart disease in children.

Evaluating Health of Emerging Economies Through the Eyes of Heart Valve Disease in the Transcatheter Era

China and India are the 2 fastest growing major world economies. However, they suffer from great differences in health policies, demographics, and rates of population growth. Whereas China has seen a steep decline in rheumatic heart disease (RHD) and a rise in life expectancy, India continues to suffer from a significant burden of RHD due to insufficient distribution of economic prosperity to health care, denser population, and ineffective application of World Health Organization RHD prevention guidelines. As China faces the burden of the world's largest geriatric population, focus has shifted to calcific aortic stenosis for which it prepares by expansions in the field of transcatheter aortic valve replacement. Conversely, India has a younger population and a lower average life expectancy. Therefore, focus in India has still not shifted to calcific aortic stenosis as a major cause of morbidity and mortality as RHD continues to constitute the bulk of valvular heart disease.

Microbial Virulence as an Emergent Property: Consequences and Opportunities

Although an existential threat from the microbial world might seem like science fiction, a catastrophic decline in amphibian populations with the extinction of dozens of species has been attributed to a chytrid fungus [1], [2], and North American bats are being decimated by Geomyces destructans, a new fungal pathogen [3]. Hence, individual microbes can cause the extinction of a species. In the foregoing instances, neither fungus had a known relationship with the threatened species; there was neither selection pressure for pathogen attenuation nor effective host defense. Humans are also constantly confronted by new microbial threats as witnessed by the appearance of HIV, SARS coronavirus, and the latest influenza pandemic. While some microbial threats seem to be frequently emerging or re-emerging, others seem to wane or attenuate with time, as exemplified by the decline of rheumatic heart disease [4], the evolution of syphilis from a fulminant to a chronic disease [5], and the disappearance of “English sweating sickness” [6]. A defining feature of infectious diseases is changeability, with change being a function of microbial, host, environmental, and societal changes that together translate into changes in the outcome of a host–microbe interaction. Given that species as varied as amphibians and bats can be threatened with extinction by microbes, the development of predictive tools for identifying microbial threats is both desirable and important.

Infective endocarditis in congenital heart disease

Congenital heart disease (CHD) has become the leading risk factor for pediatric infective endocarditis (IE) in developed countries after the decline of rheumatic heart disease. Advances in catheter- and surgery-based cardiac interventions have rendered almost all types of CHD amenable to complete correction or at least palliation. Patient survival has increased, and a new patient population, referred to as adult CHD (ACHD) patients, has emerged. Implanted prosthetic material paves the way for cardiovascular device-related infections, but studies on the management of CHD-associated IE in the era of cardiovascular devices are scarce. The types of heart malformation (unrepaired, repaired, palliated) substantially differ in their lifetime risks for IE. Streptococci and staphylococci are the predominant pathogens. Right-sided IE is more frequently seen in patients with CHD. Relevant comorbidity caused by cardiac and extracardiac episode-related complications is high. Transesophageal echocardiography is recommended for more precise visualization of vegetations, especially in complex type of CHD in ACHD patients. Antimicrobial therapy and surgical management of IE remain challenging, but outcome of CHD-associated IE from the neonate to the adult is better than in other forms of IE. Primary prevention of IE is vital and includes good dental health and skin hygiene; antibiotic prophylaxis is indicated only in high-risk patients undergoing oral mucosal procedures.

The state of heart disease in Sudan.

Cardiovascular disease (CVD) is the leading cause of mortality worldwide and an important cause of disability. In Africa, the burden of CVD is increasing rapidly and it is now a public health concern. Epidemiological data on diseases is scarce and fragmented on the continent. To review available data on the epidemiology and pattern of heart disease in Sudan. Data were obtained from the Sudan Household Survey (SHHS) 2006, annual health statistical reports of the Sudan Federal Ministry of Health, the STEPS survey of chronic disease risk factors in Sudan/Khartoum, and journal publications. The SHHS reported a prevalence of 2.5% for heart disease. Hypertensive heart disease (HHD), rheumatic heart disease (RHD), ischaemic heart disease (IHD) and cardiomyopathy constitute more than 80% of CVD in Sudan. Hypertension (HTN) had a prevalence of 20.1 and 20.4% in the SHHS and STEPS survey, respectively. There were poor control rates and a high prevalence of target-organ damage in the local studies. RHD prevalence data were available only for Khartoum state and the incidence has dropped from 3/1 000 people in the 1980s to 0.3% in 2003. There were no data on any other states. The coronary event rates in 1989 were 112/100 000 people, with a total mortality of 36/100 000. Prevalence rates of low physical activity, obesity, HTN, hypercholesterolaemia, diabetes and smoking were 86.8, 53.9, 23.6, 19.8, 19.2 and 12%, respectively, in the STEPS survey. Peripartum cardiomyopathy occurs at a rate of 1.5% of all deliveries. Congenital heart disease is prevalent in 0.2% of children. Heart diseases are an important cause of morbidity and mortality in Sudan. The tetrad of hypertension, RHD, IHD and cardiomyopathy constitute the bulk of CVD. Hypertension is prevalent, with poor control rates. A decline in rheumatic heart disease was seen in the capital state and no data were available on other parts of the country. No recent data on IHD were available. Peripartum cardiomyopathy and congenital heart disease occur at similar rates to those in other African countries.

Interventional Cardiology Perspective of Functional Tricuspid Regurgitation

A vast unmet need exists for tricuspid valve (TV) repair for functional tricuspid regurgitation (FTR) among patients undergoing left heart valve surgery. The FTR is a dynamic entity that is governed by several pathophysiologic mechanisms like TV annular dilatation, annular shape, pulmonary hypertension, left or right ventricle dysfunction, right ventricle geometry, and leaflet tethering. Treatment options for FTR are primarily surgical. No clear medical management exists for treatment of FTR. Several studies have demonstrated improvement in functional status along with tricuspid regurgitation grades among individuals undergoing concomitant TV repair as compared with those undergoing only left heart valve surgery, although data on mortality benefits are equivocal. Percutaneous TV technology may be initially useful for patients with FTR who are at high risk for open-heart surgery. Once the other percutaneous technologies for mitral, aortic, or pulmonary valve become widely available, the need for percutaneous TV procedures will be even more apparent. Initial data from animal studies have shown encouraging results. A concurrent effort is being invested to develop effective mechanistic models, right stent materials, superior valve devices along with a precise technology for valve deployment. The current prevalence of moderate-to-severe tricuspid regurgitation (TR) is estimated to be 1.6 million in the United States.1 Of these, only ≈8000 patients undergo tricuspid valve (TV) surgeries annually, most of them in conjunction with left heart valve surgeries (LHVSs).1 This has resulted in a vast unmet need of recognizing and effectively treating TR in adult populations. With the decline of rheumatic heart disease, a large proportion of the TR encountered is functional rather than organic. Functional TR (FTR) refers to the TR secondary to the left heart pathology or right heart pathology in the face of a normal TV leaflet morphology. The methods of detecting TR have evolved considerably over the years. The …

Season of birth in valvular heart disease

This study demonstrates seasonal variations of birth dates in children with congenital valvular heart disease and in adults dying from valvular heart disease. The findings are based on the 1989-98 Swiss EUROCAT data, and on 1969-94 Swiss mortality records. Seasonality was tested with aggregated monthly data using Edwards' procedure. Both data sets showed excesses between December and March, consistent in different forms of valvular disease and in both sexes. Despite the decline of rheumatic heart disease, risk factors causing season of birth effects remain relevant for congenital anomalies.

A STUDY ON CARDIOVASCULAR DISEASE PATTERN OF ADMITTED CASES IN NEWLY EMERGED NATIONAL HEART CENTRE

Cardiovascular disease is one of the global leading causes of death . Although indeveloped countries overall cardiovascular death is declining due to long term declineof rheumatic heart disease (RHD), cerebro vascular and hypertensive heart disease,heart disease is still the leading cause of death. In developing countries prevalence ofcoronary heart disease (CHD) is in increasing trend and cardiovascular disease patternis changing. Cardiovascular disease pattern of this region is revealed in this study.Total 300 study subjects, admitted from May 2000 to April 2001, 174 (58%) male and126 (42%) female and age ranged from 5 to 83 years were analyzed retrospectively.Proportionate distribution of all admitted cases was calculated and arranged inaccording with sequence order.Rheumatic heart disease was found the commonest, which constituted 27.3%, followedby coronary heart disease (21.7%) and hypertension (20.7%) respectively. Chronicobstructive pulmonary disease (COPD) with cor pulmonale (7.7%) was fourth insequence order then respectively came diabetes mellitus (DM) coexisted with CHD orhypertension, dilated cardiomyopathy (DCM), cardiac arrhythmia without organicheart disease, congenital heart disease, infective endocarditis, rheumatic fever,pericardial effusion etc. Readmission rate within one year was 12.3% and mortalityrate was 2.7%. Conclusion: Rheumatic heart disease is the commonest heart diseasefollowed by coronary heart disease and hypertension. COPD with cor pulmonale,diabetes coexisted with CHD or hypertension, DCM and cardiac arrhythmia withoutorganic heart disease are also common heart diseases.Key Words: Cardiovascular diseases, Disease pattern.