A. Melka, RHEUMATIC HEART-DISEASE IN GONDAR-COLLEGE-OF-MEDIAL-SCIENCES TEACHINGHOSPITAL - SOCIODEMOGRAPHIC AND CLINICAL PROFILE, Ethiopian medical journal, 34(4), 1996, pp. 207-216
One hundred fourteen patients with rheumatic heart disease were seen b
etween January 1994 and January 1995 at Gondar College of Medical Scie
nces Teaching Hospital. These patients were prospectively described us
ing a prepared study protocol consisting of socio-demographic variable
s, clinical findings and laboratory tests. The mean and median age of
the patients were 23 +/- 8 years and 22 years, respectively, (range =
5-50 years). About 66% of the patients were females with female to mal
e ratio of 1.9:1. Eighty five cases (74.6%) were on follow up with mea
n and median duration of 4.32 +/- 4.5 years and 3 years, respectively
(range = 1-20 years). The rest (25.4%) of the patients were new. Histo
ry findings suggestive of rheumatic fever were obtained in 26% of the
patients. Six patients (5.3%) had siblings with similar illness. Frequ
ently encountered valve lesions were combined mitral regurgitation and
stenosis seen in 29 (25.4%), followed by pure mitral stenosis in 25 (
21.9%) and mitral regurgitation in 21 (18.4%). The commonest arrhythmi
a was atrial fibrillation, observed in 22.8% of the cases. Recurrence
of rheumatic fever occurred in 11 patients (9.6%) over the study perio
d. Of these, five were regularly taking a four weekly Banzanthine peni
cillin injections. The functional classes of patients according to the
New York Heart Association's; classification were 17%, 25%, 26% and 3
2% for classes I, II, III and IV, respectively. There were 85 episodes
of decompensations. The commonest precipitating factor was drug disco
ntinuation followed by infection and arrhythmia. Most episodes have mu
ltiple causes for deterioration. Critical evaluation and education of
patients during follow up is recommended.