A total of 39 titles related to rheumatic fever or rheumatic heart disease in Malaysia were found with online literature search dating back to their inceptions and through 2014. Additional publications from conference journals were included. Nine papers were selected based on clinical relevance and future research implications. There were no population-based studies on the incidence or prevalence of ARF or RHD. In the 1980s, the incidence of admission due to ARF ranged from 2 to 21.1 per 100 000 paediatric admission per year. The burden of disease was significant in the adult population; 74.5% of patients with RHD were female, of which 77.1% were in the reproductive age group of 15-45 years old. Rheumatic mitral valve disease constituted almost half (46.7%) of all mitral valve repairs, ranging from 44.8 – 55.8 patients per year from 1997 – 2003. From 2010-2012, mitral valve interventions increased to 184 per year, of which 85.7% were mitral valve repair. In children with ARF, 25.4% - 41.7% had past history of rheumatic fever or RHD. In patients with rheumatic mitral valve disease undergoing surgical or medical interventions, only 6% reported history of ARF, none had history of GABHS pharyngitis or antibiotic prophylaxis. Only 44.7% of patients with RHD on follow-up were on intramuscular benzathine penicillin prophylaxis. Overall, there is scarcity of publications on ARF and RHD in Malaysia. Priority areas for research include determination of the incidence and prevalence of ARF and RHD, identification of high-risk populations, evaluation on the implementation and adherence of secondary preventive measures, identification of subclinical RHD especially amongst the high-risk population, and a surveillance system to monitor and evaluate preventive measures, disease progression and outcomes.
Rheumatic Fever ; Rheumatic Heart Disease

Introduction: Coronary artery fistula (CAF) is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. This is a rare defect and occurs in only 0.2% of the population. Most of the cases are congenital but acquired causes are also reported. A CAF may occur as an isolated cardiac defect or with other cardiac diseases such as rheumatic heart disease (RHD). Only a few cases of coexisting CAF and RHD have been reported. Local data reports only 0.69% CAFs associated with congenital malformations of the heart. Only 61 patients among all patients who underwent coronary arteriography in 34 years were reported to have a CAFs. We report a case of severe mitral stenosis (MS) with a double CAF from the left circumflex (LCx) artery draining into the left atrium. Case: A 46-year old female with RHD with severe MS came in due to progressive dyspnea. The coronary angiogram revealed two fistulous tracts originating from the LCx draining into the left atrium. She underwent mitral valve replacement (MVR) surgery, left atrial plication, and closure of the fistula drainage the left atrium. The postoperative course was uneventful. Discussion A CAF is often asymptomatic until the second decade of life. Untreated, this may progress and cause ischemic and heart failure signs and symptoms. The presence of MS caused elevated left atrial pressure which might have prevented the increase in the volume of blood draining from the LCx artery to the left atrium through the fistulas. Hence, the MS might have prevented the dilatation of the two fistulas. Surgical correction is also indicated in the fistulas since resolution of the mitral stenosis with MVR will decrease the LA pressure which might result to dilatation and increased drainage of the fistulas causing complications later.
Rheumatic Heart Disease

No abstract available.
Child* ; Humans ; Rheumatic Fever* ; Rheumatic Heart Disease*

No abstract available.
Child* ; Humans ; Rheumatic Heart Disease*

Background:Rheumatic heart disease is an acquired heart disease which often seen in the year of 90's. Nowaday, due to the development of health care system, population benefit much of knowledge to prevent this disease, the rate of prevenlence reduce significant. Objectives:This study aims to diagnose and prevent relapse in childen with rheumatic heart diseasewho treated in National Hospital for Pediatrict. Subjects and method:A retrospective study was conducted on 236 children with rheumatic heart diseaseor cardiac valve diseasewho admitted at Cardiology department of the National Hospital for Pediatrics from 1st January 2001 to December 31, 2005. Results:29.7% (70/236) were hospitalized for rheumatic valve disease. Among 166 hospitalized children due to continuous rheumatic heart disease, the result showed that: The types of carditis and arthritis were the most frequent and at least 22.9% (38/166) of children had definitive permanent valve lesions . 65.7% (44/76 responses) children received proper prevention. Some of them were not monitored at the center of prevention. The greater part of the rest had no knowledge of this disease. Conclusion:Rheumatic heart disease reduced but the prevalence of heart valve complication increased.\r\n", u'\r\n', u'
Rheumatic Heart Disease/ diagnosis ; therapy ; Infant

PURPOSE

The combined mitral stenosis (MS) and aortic regurgitation (AR) impose opposite loading conditions on the left ventricle. Physiologically, the relief of MS may increase the severity of AR.

Participants were Filipinos 19 years or older, admitted because of severe MS with mild to moderate AR. The outcome of percutaneous transmitral commissurotomy (PTMC) was divided into two groups: (1) significant AR that included the increase in severity of AR: mild to moderate/severe or moderate to severe AR, and (2) the insignificant AR group, which included any decrease in the severity of AR: moderate to mild or persistence of mild or moderate AR. These groups were compared from baseline, 24 hours, 1 month, and 6 months using the same echocardiographic parameters. The numerical data between significant and insignificant tricuspid regurgitation were compared using nonparametric Mann-Whitney U test and categorical data using the χ2 test.

A total of 43 participants were analyzed. At 24 hours post-PTMC, the significant AR group had significantly lower left ventricular end-diastolic dimension (3.83 vs 4.5, P = 0.008), left ventricular end-systolic dimension (2.33 vs 2.97, P = 0.017), right ventricular fraction area change (38.6 vs 48.7, P = 0.025), and left ventricular outflow tract (1.66 vs 2.02, P = 0.020) and higher systolic pulmonary arterial pressure (57 vs 32.4, P = 0.008). At 1 and 6 months, there were no significant differences in echocardiographic parameters between the significant and insignificant AR groups' left ventricular end-diastolic dimension (4.58 vs 4.5, 4.64 vs 4.57), left ventricular end-systolic dimension (3.1 vs 2.9, 2.9 vs 2.91), and systolic pulmonary arterial pressure (28 vs 34.7, 33.8 vs 32.4). Those with significant AR had a higher mean Wilkin score (mean, 10; P = 0.007) and subvalvular thickening (mean, 2.6; P = 0.005).

On short-term follow-up, the presence of mild to moderate AR before PTMC does not lead to severe AR. The outcomes regardless of the group showed a good functional class and no significant echocardiographic differences when compared.

BACKGROUND: Rheumatic fever (RF) and Rheumatic heart disease (RHD) patients Rheumatic Heart Disease (RHD) patients necessitate secondary prophylaxis with benzathine penicillin G (BPG) injection every 3 weeks to prevent recurrences and complications. Patients with rheumatic fever on regular benzathine penicillin G injection usually experience moderate to severe pain resulting to poor compliance to treatment. 

OBJECTIVES: This study aims to compare the effect of BPG diluted in lidocaine hydrochloride 1%  versus diluted water in reducing injection pain in patients with RF and RHD.

METHODS: This is a randomized double-blind crossover study conducted at the PCMC OPD. Thirty-three patients diagnosed with RF and RHD were divided into 2 groups; the first group received BPG diluted in sterile water followed by BPG diluted in lidocaine hydrochloride  1% after 21 days, the second group received the same medication in reverse order. Pain scale was measured using Universal pain assessment tool immediately after injection. Paired T test was used to compare the pain score results of the two groups.

RESULTS: Pain score was significantly less in patients who received BPG diluted in lidocaine hydrochloride 1%; from an average pain score of 4.88 to 0.63 (p<0.0001), among those who received BPG diluted in sterile water. No adverse effects were seen in all patients.

CONCLUSION: This study concluded that BPG diluted in lidocaine hydrochloride 1% significantly and safely reduced post-injection pain. In all patients diagnosed with RF and RHD, BPG injection should be diluted in lidocaine hydrochloride 1% to decrease injection pain and improve patient's compliance.

Adult ; Female ; Humans ; Rheumatic Heart Disease ; therapy ; Treatment Failure

Reiter's syndrome is a clinical triad of urethritis, conjunctivitis, and arthritis, but the characteristic mucocutaneous lesion occurs very frequently. Therefore, Reiters syndrome in fact might better be considered a tetrad, consisting in its complete form of urethritis, arthritis, conjunctivitis, and mucocutaneous lesions. In initial stage of the disease, the arthritis usually appear after the urethritis and conjunctivitis have been made. The arthritis is usually of subacute onset, reaching its full intensity within a few weeks in most cases. Additionally a man with Reiters syndrome who developed aortic insufficiency with no evidence of syphilis or rheumatic heart disease has been reported. Two cases of Reiters syndrome are presented with the review of the literature: the first case was a 60 years old male who had non-gonococcal urethritis with mucous purulent discharge, conjunctivitis, polyarthritis, and aortic insufficiency; the second case was a young man aged 21 years who had the characteristic conjunctivitis and a past history of urethritis, and he also has had obvious keratodermia blenorrhagica and polyarthritic symptoms and signs.
Arthritis ; Conjunctivitis ; Humans ; Male ; Rheumatic Heart Disease ; Syphilis ; Urethritis

Clinical study was done on 119 patients with atrial fibrillation in the aspect of underlying diseases, particulary. The results were as follow : 1) In the underlying diseases of atrial finbrillation, rheumatic heart disease, hepertension and ischemic heart disease were common, which occupied 27.8%, 22.7% and and 15.1%, respectly. No apparent underlying disease was found in 21.0%, but in the transient atrial fibrillation, no apparent underlying disease in 42.9%. 2) There were no significant correlations between the ventricular rate, amplitude of f wave and underlying diseases of atrial fibrillation. 3) Complications were found in 29.4% of all cases, such as congestive heart failure(22.7%), embolism(6.7%). Otherwise, atrial fibrillation without underying cardiovascular diseases, congestive heart failure was found only(7.7%).
Atrial Fibrillation* ; Cardiovascular Diseases ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Humans ; Myocardial Ischemia ; Rheumatic Heart Disease