CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 3, April 2013
82
AFRICA
found in seven patients, who were excluded from the analysis.
RHD was found in 373 patients and 350 of these met the criteria
for definite RHD. Of these 350 patients, 41 had a previous
diagnosis of RHD and were excluded from the analysis. The
remaining 309 patients, newly diagnosed as definite RHD,
comprised this analysis (Fig. 1).
Demographic information for the study population can be
found in Table 1. The median age in males and females was
30 years, with an interquartile range of 20. Most cases were
of low socio-economic status with little or no education and
unemployed.
Cardiovascular symptoms, including palpitations, fatigue,
chest pain, oedema and syncope were found in 85.1% of the
study enrolments. Palpitations were by far the most common
complaint, being found in 84.5% of the total population, with
equal distribution between males and females (Table 2).
Complications were found in 49% (152/309) of the newly
diagnosed RHD cases. Heart failure (46.9%) was the commonest
complication, followed by pulmonary hypertension (32.7%),
atrial fibrillation (13.9%), acute recurrence of rheumatic fever
(11.4%), infective endocarditis (4.5%) and stroke (1.3%) (Table
2). Pulmonary hypertension was observed in about 33% of cases
with no difference between male and female respondents. The
mitral (70%) and aortic valves (30%) were the most affected
valves in those with infective endocarditis.
Mitral regurgitation (MR) was the most common valvular
lesion, followed by mixed mitral and aortic regurgitation,
mitral stenosis and mixed-valve disease (Table 3). The average
left ventricular end-diastolic diameter (LVEDD), average left
ventricular end-systolic diameter (LVESD) and average ejection
fraction (LVEF) for cases with MR was 65 mm (normal range
35–55 mm), 50 mm (normal range 25–40 mm) and 54% (normal
range 40–70%), respectively, with 52% of the cases presenting
with severe MR. Those with aortic regurgitation (AR) had
average LVEDD, LVESD and LVEF of 58 mm, 44 mm and
56%, respectively, with 46% presenting with severe AR; 49% of
the mitral stenosis cases were graded as severe (Table 3).
An analysis of factors associated with congestive heart
failure was performed. Atrial fibrillation was the commonest
complication associated with congestive heart failure (81.4%
CHF vs 18.6% no CHF,
p
<
0.05), followed by acute rheumatic
fever recurrence (71.4% CHF vs 28.6% no CHF,
p
=
0.002),
and infective endocarditis (78.6% CHF vs 21.4% no CHF,
p
=
0.015) (Table 4).
In addition, 50% of cases with stroke presented in atrial
fibrillation. The rest had mitral stenosis in sinus rhythm; 35
cases presented with recurrence of ARF. Average ASO titre and
Fig. 1. Flow chart of study participants’ enrollment.
Referred for suspected RHD (
n
=
380)
Congenital Heart
Disease (
n
=
7)
ASD
(
n
=
4)
VSD
(
n
=
1)
PAVSD
(
n
=
1)
PS
(
n
=
1)
RHD (
n
=
373)
Possible
RHD (
n
=
9)
Probable
RHD (
n
=
14)
Definate RHD
(
n
=
350)
Pre-existing
diagnosis
(
n
=
41)
New
diagnosis
(
n
=
309)
TABLE 1. DEMOGRAPHIC PROFILE OF RHD CASES
Patient characteristics
n
=
309 (%)
Age (years), median (IQR)
30 (20)
Gender
Male
113 (36.6)
Female
196 (63.5)
Education
None
23 (7.4)
Primary
142 (45.9)
Secondary
99 (32.0)
Tertiary (college/university)
45 (14.6)
Occupation
Peasant farmer
147 (49.1)
Civil servant
44 (14.7)
Small business owner
33 (11.4)
Student/pupil
73 (24.58)
Medication after diagnosis
Diuretics
299 (98.4)
Benzathine penicillin
268 (97.1)
Beta-adrenergic blockers
223 (77.2)
Digoxin
212 (74.6)
Angiotensin converting enzyme inhibitors
43 (16.5)
Warfarin
48 (18)
Antiplatelates
9 (3.4)
Beta-adrenergic blockers
223 (77.2)
Calcium channel blockers
3 (1.2)
Diuretics
299 (98.4)
Ace inhibitors
43 (16.5)
Height (cm), median (IQR)
162 (12)
Weight (kg), mean (SD)
55.2 (13.8)
Pulse rate (beats/min), median (IQR)
90 (33)
IQR
=
inter-quartile range; SD
=
standard deviation.
TABLE 2. CLINICAL PRESENTATIONAND COMPLICATIONS
Complication
Total
n
(%)
Males
n
(%)
Females
n
(%)
Total cases
309 (100) 113 (36.6) 196 (63.5)
Symptoms
Palpitations
263 (85.1) 117 (44.4) 146 (56.6)
Fatigue
261 (84.5) 138 (52.8) 123 (47.2)
Chest pain
138 (44.7) 59 (42.7) 79 (57.3)
Oedema
112 (36.2) 36 (32.1) 76 (67.9)
Syncope
20 (6.4)
13 (65)
7 (35)
Complications
Congestive heart failure
145 (46.9) 56 (49.5) 89 (45.4)
Acute rheumatic fever
35 (11.4) 16 (14.3)
19 (9.7)
Stroke
4 (1.3)
1 (0.9)
3 (1.5)
Clinically symptomatic peripheral embolism 0
0
0
Major bleeding
0
0
0
Infective endocarditis
14 (4.5)
7 (6.2)
7 (3.6)
Atrial fibrillation
43 (13.9) 16 (14.2) 27 (13.8)
Pulmonary hypertension
98 (32.7) 37 (32.7) 61 (31.1)
