Mild Carditis Research Articles

The detection of ventricular dysfunction and carditis in children with Kawasaki disease using equilibrium multigated blood pooling ventriculography and 99Tcm-HMPAO-labelled WBC heart scans.

Thirty-seven children (11 girls, 26 boys; aged 2.8 +/- 2.2 years) with Kawasaki disease (KD) were included in the study. The biventricular functions were evaluated by equilibrium multigated blood pooling ventriculography (EMBPV) and the severity of carditis was decided by Tc-hexamethylpropyleneamine oxime (HMPAO) labelled white blood cell (WBC) heart scans (Tc-WBC). The results showed that 43% (16/37) of the KD cases with the severe carditis by Tc-WBC had the worst left ventricular ejection fraction (LVEF) (55.4 +/- 15.6%) and right ventricular ejection fraction (RVEF) (43.7 +/- 12.2%) by EMBPV; 24% (9/37) of the cases with the mild carditis had the best LVEF (63.5% +/- 8.2%) and RVEF (53.7% +/- 11.2%); the remaining 32% (12/37) had moderately severe carditis and biventricular function (LVEF: 58.2 +/- 17.2% and RVEF: 46.9 +/- 19.5%). Because Tc-WBC cannot only detect the severity of carditis but also predict impairment of ventricular function accurately, the choice of Tc-WBC should be preferable for KD-a common inflammatory cardiovascular disease in children.

SYDENHAM'S CHOREA: A NEW LOOK AT AN OLD DISEASE

SUMMARYEight children with Sydenham's chorea were studied to illustrate the clinical characteristics and the outcome of the disease. Their ages ranged from 8 to 13 years and the male to female ratio was 1.7:1. Most of them had hemichorea, which frequently affected the right side of the body. The common presenting manifestations were involuntary movements, facial grimacing, clumsiness, and emotional instability. The duration of chorea ranged from one week to three years, with a median of 11 weeks. One half of the patients had associated mild carditis. Recurrences of chorea occurred only among patients who were not maintained on continuous penicillin prophylaxis. Haloperidol seemed to be an effective and tolerable agent in controlling the motor manifestations of the disease.

THE EFFECT OF INTENSIVE AND PROLONGED THERAPY WITH CORTISONE AND HYDROCORTISONE IN FIRST ATTACKS OF RHEUMATIC CARDITIS

Forty patients (39 children and 1 adolescent) with clinical evidence of carditis during first rheumatic attacks were treated with large doses of oral cortisone or oral hydrocortisone for periods varying from 9 weeks to 12 months. Twenty-nine of these forty patients received treatment within 3 weeks of onset. After follow-up observations ranging from 6 to 22 months, 24 of the 29 patients have no evidence of heart disease. Patients with severe as well as mild carditis responded equally well. Eleven patients treated later than 3 weeks after onset did less well: only 2 have normal hearts, 8 have rheumatic heart disease and 1 patient died. The results of this study suggest that cortisone given early in the course of the rheumatic attack in doses sufficiently large to suppress the inflammatory reaction completely and continued until the disease has run its course, may reduce the incidence of residual heart disease. Further studies based on a large series of cases with adequate controls are needed to establish the value of this regimen. Eleven of the forty patients developed serious side effects. In 4 the symptoms were of sufficient severity to necessitate cessation of therapy. In the remainder the untoward reactions were controlled by reducing the dosage of the steroid.

Q-T INTERVAL DURING ACTIVE AND INACTIVE RHEUMATIC FEVER

The Q-Tc in 79 normal children ranging in age from 2 to 12 years was found to be 0.418 with a standard deviation of 0.016. The Q. Tc was studied in 208 children ranging in age from 3 to 13 years during active rheumatic fever and chorea. One hundred nineteen of these patients were subsequently followed in the cardiac clinics. The P-R interval was studied simultaneously, and observation were made in regard to the presence or absence of resultant organic heart disease. A significant number of patients showed prolongation of the Q-Tc value during the acute illness, far more so in those with rheumatic carditis than with polyarthritis or chorea alone. During the inactive phase, a number of patients maintained a prolonged Q-Tc value. The Q-Tc value in patients with rheumatic fever is an additional laboratory aid which may help in determining the presence of active carditis. The prolongation of the Q-Tc value in polyarthritis and in chorea in the absence of other clinical findings should suggest further observation for the possible presence of a mild carditis. However, in evaluating patients whose Q-Tc is above normal and in whom the presence of active carditis is otherwise questioned, consideration must be given to the fact that the Q-Tc has been found to exceed the upper limit of normal in some normal children. These findings show that, following active rheumatic fever, in some patients the Q-Tc value may remain prolonged over long periods of time in the absence of any manifest clinical activity or change in the cardiac status of the patient. Therefore it is the opinion of the authors that when careful evaluation over a period of time shows no other clinical or laboratory evidence of rheumatic activity, the sole finding of a Q-Tc remaining above normal range should not be considered as indicative of persistence of active carditis.