Some notes on the history of rheumatic carditis

The history of rheumatic heart disease is briefly surveyed. Mitral regurgitation was recognized as the dominant leison in acute carditis in the 1830s. This diagnosis fell out of favour in the early twentieth century. Also valvular leisons were then considered to be less important than myocardial disease as a cause of symptoms in chronic rheumatic heart disease. Successful mitral valvotomies in 1948 corrected this view. Mitral stenosis takes years to develop after acute valvulitis. Studies from the rheumatic fever research unit at Taplow showed absence of cardiac dilatation in first attacks of rheumatic carditis, poor prognosis with pericardial effusions, changing murmurs recorded by phonocardiography and cardiac output studies that satisfied treatment by bed rest. The multicentre trial of cortisone, adrenocorticotrophic hormone (ACTH) and salicylates showed no differences in development of chronic valvular disease. There is need for a more specific test for rheumatic activity than the erythrocyte sedimentation rate (ESR). It is hoped that test can be developed to identify the minority of children at risk from rheumatic fever after a streptococcal throat infection in order to target antibiotic use. The declining prevalence of rheumatic fever is confined to the more prosperous countries. It remains common in the developing world. Penicillin prophylaxis is the sole advance in therapy. Better socio-economic environments are needed to reduce prevalence. (AU)

Lessons from reporting 100, 000 Jamaican electrocardiograms

The screening programme of the Heart Foundation of Jamaica has found hypertension in 71 percent of women and 47 percent of men. Of these patients, 13 percent were newly discovered hypertensives. Left ventricular hyperthrophy was present in 18 percent of hypertensive women and 27 percent of men. Inadequate control of raised blood pressure was a frequent finding. Ischaemic electrocardiographic (ECG) changes were only found in 4 percent of the 14,739 patients seen in the past two years but this is an underestimation of the prevalence of ischaemic heart disease. Arrhythmias seen over 15 years were usually benign, of sinus origin or ectopics in the absence of heart disease. Uncontrolled atrial fibrillation remains the most serious arrhythmia encountered and usually in hypertensive patients. Obesity found in 80 percent of women is a problem requiring public education. `Silent' ischaemia in diabetic and left ventricular hypertrophy indicate the need for ECG examination in all newly diagnosed patients with either condition, and annual ECGs thereafter. (AU)

Lessons from reporting 100, 000 Jamaican electrocardiograms

The screening programme of the Heart Foundation of Jamaica has found hypertension in 71 percent of women and 47 percent of men. Of these patients, 13 percent were newly discovered hypertensives. Left ventricular hyperthrophy was present in 18 percent of hypertensive women and 27 percent of men. Inadequate control of raised blood pressure was a frequent finding. Ischaemic electrocardiographic (ECG) changes were only found in 4 percent of the 14,739 patients seen in the past two years but this is an underestimation of the prevalence of ischaemic heart disease. Arrhythmias seen over 15 years were usually benign, of sinus origin or ectopics in the absence of heart disease. Uncontrolled atrial fibrillation remains the most serious arrhythmia encountered and usually in hypertensive patients. Obesity found in 80 percent of women is a problem requiring public education. `Silent' ischaemia in diabetic and left ventricular hypertrophy indicate the need for ECG examination in all newly diagnosed patients with either condition, and annual ECGs thereafter.