Acute rheumatic fever and rheumatic heart disease in a rural central Australian aboriginal community

A retrospective study of clinical case records was conducted at the health centre of a rural central Australian Aboriginal community to determine the frequency of acute rheumatic fever and of rheumatic heart disease between 1978 and 1987. The case records of 976 residents over 5 years of age were examined for evidence of the clinical indicators of acute rheumatic fever or rheumatic heart disease; together they contributed 8015 person-years of study. During the 10-year study period, 18 patients developed acute rheumatic fever and 12 patients had rheumatic heart disease. The annual incidence of acute rheumatic fever (first and recurrent attacks) for children aged 5-14 years was 815 per 100,000 person-years. For the residents aged 5 years and over, the point prevalence for rheumatic heart disease at the end of 1987 was between 7.9 and 12.3 per 1000 persons, according to health clinic records and the official population census, respectively. These rates are similar to those reported for Third World countries. Preventive measures must include efforts by health professionals to help to alleviate the adverse living conditions in Aboriginal communities.     

新疆墨玉县及皮山县医院维吾尔族住院病人心血管病病种10年演变回顾性研究

目的：探讨新疆和田地区墨玉县及皮山县医院维吾尔族心血管病病种近10年演变趋势。方法：收集新疆和田地区墨玉县及皮山县医院内科1996年1月～2005年12月住院维吾尔族心血管病患者16654例住院病历，统计冠心病、原发性高血压病、风湿性心脏病、原发性心肌病、先天性心脏病、肺原性心脏病构成比，并分析心血管病病种近10年演变情况。结果：16654例中，原发性高血压病的构成比由1996年的12．6％上升为2005年的21．0％，冠心病的构成比由1996年的8．6％上升为2005年的16．7％，风湿性心脏病的构成比由1996年的1．3％上升为2005年的3．2％，原发性心肌病的构成比由1996年的1．2％上升为2005年的2．3％。从1996年到2005年原发性高血压病、冠心病构成比呈明显增高趋势（P均〈0．05），风湿性心脏病、原发性心肌病构成比呈逐渐增高趋势（P均〈0．05），先天性心脏病、肺原性心脏病的构成比无演变趋势（P均〉0．05）。结论：应加强此地区人群心血管病，尤其原发性高血压病，冠心病的预防工作。     

新疆墨玉县10，906例维吾尔族住院病人心血管病种10年回顾

目的探讨新疆维吾尔族心血管病病种近10年演变趋势。方法新疆和田地区墨玉县医院内科1996年～2005年住院病例总数及心血管病病种均用统一表格填写、统计冠心病、原发性高血压、风湿性心脏病、原发性心肌病、先天性心脏病、肺原性心脏病的构成比,分析其演变情况。结果墨玉县维吾尔族内科住院病人当中原发性高血压的构成比1996年为13.7%,2005年上升为22.4%,冠心病的构成比1996年为7.6%,2005年上升为14.2%。风湿性心脏病的构成比1996年为1.6%,2005年上升为3.5%、原发性心肌病的构成比1996年为1.9%,2005年上升为3.3%、肺原性心脏病的构成比1996年为4.4 05年上升为5.7%。原发性高血压、冠心病呈明显增多趋势(P均<0.05)。风湿性心脏病、原发性心肌病逐渐有所增多趋势(P均<0.05)。结论应加强该地区人群心血管病,尤其高血压,冠心病的预防工作。     

One year echocardiographic study of rheumatic heart disease at Enugu, Nigeria

BACKGROUND: Rheumatic heart disease is one of the commonest causes of heart disease in Nigeria. Previous studies on rheumatic heart disease in Nigeria were either clinical or retrospective echocardiographic studies. This study was aimed at determining the burden of chronic rheumatic mitral valve disease, pattern of valvular involvement, severity and associated valvular lesions, using echocardiography. PATIENTS AND METHODS: Between May, 2004 and April 2005, patients with symptomatic rheumatic heart disease, seen in the cardiac clinics of University of Nigeria Teaching Hospital, Enugu, were recruited for the study. The patients were investigated non-invasively with M-mode, Two-dimensional, Pulsed wave, Continuous wave and colour flow Doppler echocardiographic techniques in order to assess the mitral and other intracardiac valves for evidence of rheumatic heart disease. RESULTS: There were a total of 55 patients, 39 (70.9%) females and 16 (29.1%) males with a mean age of 29.34 +/- 11.57 years. Mitral valve disease was found in 54 (98.2%) and isolated aortic valve disease in 1 (1.8%) of cases. Mitral regurgitation occurred in 64.8%, mixed mitral valve disease in 25.9% and pure mitral stenosis in 9.3%. Mitral valve disease was associated with aortic valve disease in 33.3%, with tricuspid valve disease in 24.1% and with functional pulmonary incompetence in 9.3% of cases. CONCLUSION: Rheumatic heart disease in Nigeria is essentially a disease of the mitral valve as seen elsewhere in the world. Echocardiography should be done routinely for patients with rheumatic heart disease to facilitate accurate diagnosis and definitive treatment.     

Challenging perceptions of non-compliance with rheumatic fever prophylaxis in a remote Aboriginal community

AIM: To identify factors that affect rheumatic fever prophylaxis for remote-living Aboriginal patients, and to determine the proportion who received adequate prophylaxis. DESIGN AND SETTING: Interview (with analysis based on principles of grounded theory) of patients with a history of rheumatic fever or rheumatic heart disease and their relatives, and health service providers in a remote Aboriginal community; audit of benzathine penicillin coverage of patients with rheumatic heart disease. PARTICIPANTS: 15 patients with rheumatic heart disease or a history of rheumatic fever, 18 relatives and 18 health care workers. RESULTS: Patients felt that the role of the clinic was not only to care for them physically, but that staff should also show nurturing holistic care to generate trust and treatment compliance. Differing expectations between patients and health care providers relating to the responsibility for care of patients absent from the community was a significant factor in patients missing injections. Neither a biomedical understanding of the disease nor a sense of taking responsibility for one's own health were clearly related to treatment uptake. Patients did not generally refuse injections, and 59% received adequate prophylaxis (> 75% of prescribed injections). CONCLUSION: In this Aboriginal community, concepts of being cared for and nurtured, and belonging to a health service were important determinants of compliance.     

心肌抗体结合链球菌膜抗原吸附试验对心血管疾病的诊断意义

目的　探讨心肌抗体 (HRA)结合链球菌膜抗原吸附试验对心血管疾病的诊断意义。方法　应用酶免疫斑点法检测 117例各种心脏疾病患者和 3 2例正常人血清的HRA ,并将测得的阳性血清用A组链球菌膜抗原进行吸附试验。结果　风心病、原发性心肌病、病毒性心肌炎、缺血性心脏病和其他心脏病患者HRA阳性率的分别为 65 7%、5 7 9%、5 0 %、2 6 7%和 2 5 % ,吸附试验阳性率则分别为 73 9%、18 2 %、11 1%、0 %和 0 %。吸附后风心病的阳性率明显高于原发性心肌病或病毒性心肌炎 (P <0 0 1)。结论　应用酶免疫斑点法检测HRA结合链球菌膜抗原吸附试验 ,既可提高风心病诊断的特异性 ,也有利于各种心脏病的鉴别     

风湿性心脏病围手术期的健康教育

目的探讨围手术期的健康教育对患者术后恢复的影响。方法 2009年1月～2012年1月选择在我院治疗的风湿性心脏病患者82例为研究对象,随机分为研究组和对照组各41例。研究组在围手术期给予健康教育,对照组仅给予常规护理。比较两组恢复情况。结果研究组健康知识掌握情况得分和满意度高于对照组,差异有统计学意义(P<0.01)。两组出院后随访1年,死亡率差异无统计学意义,余随访项目差异均有统计学意义(P<0.05或P<0.01)。结论对风湿性心脏病患者围手术期进行健康教育,可以改善预后。     

食道超声心动图及血浆纤溶活性检测探讨风湿性心脏病栓塞危险性

目的:探讨风湿性心脏病(风心病)血栓前状态(PTS)及血栓形成机制。方法:经食管超声心动描记术(TEE)检查风心病患者203例,确定心腔内云雾状回声、血栓形成、左心房增大情况,同时检测15例风心病房颤患者和15例正常人的血液血浆假血友病因子抗原(vWF:Ag)、血小板激活标记物一血小板α颗粒膜蛋白(GMP-140)、血浆纤维蛋白肽A(FPA)、血浆纤维蛋白D-二聚体(D-D)水平。评实PTS的存在并探讨其在血栓栓塞过程中的作用。结果:风心病患者90.1％发现云雾状回声、血栓形成30.5％,其中心房纤颤者与窦性心律者比较血栓形成差异有显著性(P<0.001)。血液学指标:VWF:AG、GMP-140、FPA和D-D血浆浓度均明显高于正常对照组(P<0.01)。结论:风心病房颤患者存在血栓栓塞的基础-PTS,凝血系统异常尤为显著,且TEE检测左房自发性超声对比现象(LASEC)是存在血栓栓塞危险性的有力预测因子,有较高的临床应用价值。     

Changing pattern of heart diseases in Shanghai from the 1950s to 1980s

Objective　To determine the pattern of dynamic change in types of heart diseases in the past 4 decades for providing a reference to treatment and prevention of heart diseases in China.Methods　All adult cardiac patients admitted to the Zhong Shan Hospital and Hua Shan Hospital from 1948 to 1989 were analyzed. The constituent ratio of different heart diseases in the 1950s, 1960s, 1970s and 1980s was compared.Results　The percentage of heart diseases among medical inpatients increased in each of the recent 4 decades, from 9.89%, 15.69%, 20.90% to 23.54% respectively. The constituent ratio of different heart diseases changed, coronary heart disease constituted the highest proportion, next came rheumatic heart disease, and congenital heart disease was in third place. Congenital heart disease, myocarditis, cardiac dysrhythmia without organic heart disease, cardiomyopathy and endocarditis increased, rheumatic heart disease, pulmonary heart disease and hypertensive heart disease apparently decreased; syphilitic heart disease could rarely be encountered.Conclusion　China is now facing a low overall death rate, a long life expectancy and an aging population. The incidence of heart diseases increased gradually and patterns of heart diseases kept changing. The overall trend is that heart diseases which were not related to infection are increasing while heart diseases related to bacterial infection are decreasing.     

Health of Aboriginal and Torres Strait Islander children in remote Far North Queensland: findings of the Paediatric Outreach Service

AIM: To describe the pattern of disease and other health problems in children living in remote Far North Queensland (FNQ). DESIGN, SETTING AND PARTICIPANTS: Retrospective review of the FNQ Paediatric Outreach Service's Medical Director database for the period June 2001 to February 2006. Three subpopulations were compared: children from predominantly Aboriginal communities, predominantly Torres Strait Islander communities, and other communities. All children referred to the service during the study period were reviewed. MAIN OUTCOME MEASURES: Number of children seen and common diagnoses. RESULTS: 3562 children were referred during the study period, and a total of 3932 diagnoses were made; 56% of the paediatric population of the Aboriginal communities and 23% of the paediatric population of Torres Strait Islander communities were seen. Of 40 separate diseases/health problems reviewed, the three most common reasons for presentation were chronic suppurative otitis media, suspected child abuse and neglect, and failure to thrive. In the paediatric population of Aboriginal communities, the prevalence of fetal alcohol spectrum disorder was at least 15/1000 (1.5%), and in Torres Strait Islander children, rheumatic heart disease prevalence was at least 6/1000 (0.6%). Rheumatic fever rates were among the highest in Australia. CONCLUSION: Rates of preventable complex and chronic health problems in Aboriginal and Torres Strait Islander children in remote FNQ are alarmingly high. Areas requiring urgent public health intervention include alcohol-related conditions and rheumatic fever.     

十年来武汉地区充血性心力衰竭12495例次临床分析

本文报告武汉地区心衰12495例次的病因构成比,对风心病、冠心病、肺心病、高心病、心肌病等5种主要病因与性别、年龄、诱因之间的关系以及影响转归的因素进行讨论。结果表明:心脏病住院患者病因构成比中,风心病明显下降,但仍居首位;冠心病上升,占第二位;高心病减少;心肌病并不少见。20岁以下心衰死亡者风心病占91.0％,肺心病预后仍较差,病死率最高,感染诱发心衰高达89.5％,因心衰恶化死亡者占43.3％。     

风湿免疫病患者并发心血管疾病的研究进展

风湿免疫病是一组常见的慢性疾病，主要影响关节、肌腱、韧带、骨骼和肌肉组织，这类疾病可导致身体的残疾。尽管由于早期的诊断，积极有效的治疗，在过去的几十年里，风湿免疫病患者的死亡率明显下降，然而，和正常人群相比，风湿免疫病患者的死亡率仍然很高。流行病学证据显示较高的死亡率归因于风湿免疫病患者较高的并发症，尤其是心血管并发症，如缺血性心脏疾病、心瓣膜疾病、心肌病、心包疾病和心脏传导系统的异常。尽管风湿免疫病患者伴发心血管疾病的机理尚不完全清楚，但是传统心血管病的风险因子如吸烟、缺乏锻炼、高血压、高血脂、高血糖，风湿免疫病患者体内持续的慢性炎症和药物治疗带来的副作用如糖皮质激素的长期应用等可能是风湿免疫病患者伴发心血管疾病的主要原因。风湿免疫病可增加患心血管疾病的风险，而心血管疾病又是风湿病患者死亡的首要原因。因此有效的预防和治疗心血管并发症非常重要，了解风湿免疫病患者的心血管疾病的伴发情况，可以更好的帮助患者预防这些并发症，延长寿命，提高生活质量。本文综述了近年来风湿免疫病患者伴发心血管疾病的临床常见情况及这些伴发疾病的发病机理和预防治疗的研究进展。      

老年人风湿性心脏瓣膜病67例临床分析

报道了近30年来我院收治的67例老年风湿性心脏瓣膜病患者的临床状况,提示风湿热的发病率及风心病的患病率在下降,但老年风心病者的住院人数在逐渐增长。他们的临床表现有其特殊性,风湿活动不典型,病情经过缓和,预后较好,可合并存在冠心病,高血压等其他疾病。从本组女性患者的生育史中提示老年风心病者很可能是在青中年以后首次罹患风湿热。在对老年风心病者的处理中应加强抗风湿治疗。     

Heart failure: epidemiology and prevention in India

Reliable estimates of heart failure are lacking in India because of the absence of a surveillance programme to track incidence, prevalence, outcomes and key causes of heart failure. Nevertheless, we propose that the incidence and prevalence rates of heart failure are rising due to population, epidemiological and health transitions. Based on disease-specific estimates of prevalence and incidence rates of heart failure, we conservatively estimate the prevalence of heart failure in India due to coronary heart disease, hypertension, obesity, diabetes and rheumatic heart disease to range from 1.3 to 4.6 million, with an annual incidence of 491 600-1.8 million. The double burden of rising cardiovascular risk factors and persistent 'pre-transition' diseases such as rheumatic heart disease, limited healthcare infrastructure and social disparities contribute to these estimates. Staging of heart failure, introduced in 2005, provides a framework to target preventive strategies in patients at risk for heart failure (stage A), with structural disease alone (B), with heart failure symptoms (C) and with end-stage disease (D). Policy-level interventions, such as regulations to limit salt and tobacco consumption, are effective for primordial prevention and would have a wider impact on prevention of heart failure. Clinical preventive interventions and clinical quality improvement interventions, such as treatment of hypertension, atherosclerotic disease, diabetes and acute decompensated heart failure are effective for primary, secondary and even tertiary prevention.     

490例房颤病人回顾性分析

目的:探讨房颤发生的原因与年龄、性别、民族的关系。 方法 :对心电图和 /或动态心电图确诊为房颤的 490例住院病人 ,依据病因、年龄、性别、民族分组 ,进行回顾性分析。结果 :房颤以风心病房颤和冠心病房颤最为常见 ,分别为 31.6 %和 2 1.4%,其次是特发性房颤 (2 0 .6 %)和高心病房颤 (11.6 %)。房颤不同病因的年龄、性别和民族的构成差异明显 ,在风心病房颤病人中 ,中年龄组 (4 0～ 6 0岁 )占 5 2 .90 %,女性占 5 9.35 %;冠心病房颤病人中 ,老年组 (>6 0岁 )占 80 .95 %,男性占 81.90 %;特发性房颤病人各年龄组均有分布 ,男性明显多于女性 ,男性占74.2 5 %;风心病房颤病人的平均年龄 ,维吾尔族为 45 .0 2岁 ,与汉族 5 4.2 5岁存在显著性差异。 结论 :房颤各种病因的年龄、性别和民族各有差异 ,年龄因素对参估房颤病因有一定的参考价值。     

川西平原中小学生风湿热及风湿性心脏病流行病学调查

目的：了解川西地区风湿热及风心病流行情况。方法：按照全国统一方案对5～18岁学生进行风湿热发病监测及风心病患病率调查。结果：川西平原地区风湿热发病率为12．87／10万。城市与农村无明显差异(分别为12.74／10万及12．94／10万)，男女间无明显差异。该病以9～15岁多发，主要见于秋冬季，且全部病例均患有关节炎，其中83．3％合并心脏损害。风心病患病率为11％o。结论：对川西地区中小学生进行风湿热发病监测及社区控制是必要和有效的。     

Profile of cardiac diseases in Ethiopian children

A review of cardiac admissions to the Ethio-Swedish Children's Hospital from January 1981 to December 1988 revealed 365 cases. Patients were included in the study if they had clinical, laboratory and echocardiographic (M, 2D-Modes, doppler) proofs of the specific disease entity. One hundred and ten patients were eligible. This accounted for 0.65% of all admissions (N = 16,905). Rheumatic heart disease accounted for 54.5% (N = 60), congenital heart disease for 35.5% (N = 39), and acquired heart disease of nonrheumatic origin for 10% (N = 11) or cardiac admissions. Of patients with rheumatic heart disease, the mitral valve was involved in 41.7% (N = 25). Pure mitral stenosis was seen in 8.3% (N = 5). Ventricular septal defect was seen in 33.3% (N = 13) of patients with congenital heart disease. The mean hospital stay for patients with rheumatic heart disease was 35.4 days, and 24.7 days for patients with congenital heart. As rheumatic heart disease predominates, methods for decreasing its incidence are discussed.     

Mitral stenosis in a girl of five years

Mitral stenosis(MS) detected below the age of 20 years is called juvenile mitral stenosis (JMS). JMS constitute 25-40 % of all cases of isolated mitral stenosis, though overall incidence of rheumatic fever and rheumatic heart disease (RHD) within mixed population is 7.5- 7.8 per thousand. The patient was 5 years old girl hailing from Modhupur, Tangail got herself admitted into CCU Mymensingh Medical College Hospital with the complaints of low grade fever, shortness of breath and also associated with failure to thrive. She was ill looking, mildly anaemic. Precordial examination revealed apex beat was in the left 5th intercostals space, tapping in nature, palpable P(2). There was left parasternal heave. 1st heart sound loud, pulmonary component of the 2nd heart sound was accentuated, opening snap with mid diastolic murmur with pre systolic accentuation. Routine blood examination reveals leucocytosis with raised ESR. C-reactive protein (CRP) and ASO titre were significantly raised. X-ray chest P/A view showing the features of mitral stenosis. Echocardiography showing MS (moderate) with pulmonary hypertension. She was treated with antibiotics and other relevant drugs and discharge with an advice for follow up and take preparation for cardiac intervention.     

2004—2015年中国循环系统疾病死亡谱特征分析

背景 循环系统疾病中的心脑血管疾病已成为影响中国人寿命的"第一杀手",患病率和死亡率仍处于上升阶段。揭示循环系统疾病城乡别、性别、地区别死因顺序及其变化趋势,将为预防和控制循环系统疾病的发生发展提供科学依据。 目的 分析我国2004—2015年循环系统疾病中以心脑血管为主的疾病死亡谱特征,即城乡别、性别、地区别死因顺序及其变化趋势。 方法 利用2004—2015年"全国疾病监测系统死因监测数据集"所定义的"循环系统疾病"资料,选取其中各类别疾病的死亡数和死亡率资料,应用SPSS 13.0统计软件,采用χ2检验方法分析各类别循环系统疾病的城乡别、性别、地区别死亡率的差异及变化趋势。 结果 2004—2013年各年的死因顺位排序为脑血管病→缺血性心脏病→循环系统的其他疾病→高血压心脏病/肾脏病→风湿热和风湿性心脏病;2014—2015年各年死因顺位排序为脑血管病→缺血性心脏病→高血压心脏病/肾脏病→循环系统的其他疾病→风湿热和风湿性心脏病。2006—2015年,脑血管病、缺血性心脏病死亡率呈逐年上升趋势;2004—2015年,高血压心脏病/肾脏病死亡率逐年缓慢上升;风湿热和风湿性心脏病死亡率各年变化不大;循环系统的其他疾病死亡率呈双波浪变化,其中2006年和2013年为波峰。城乡别死亡率：脑血管病各年差异均有统计学意义（P<0.05）,风湿热和风湿性心脏病除2006、2015年外,高血压心脏病/肾脏病除2005年外,缺血性心脏病除2015年外,循环系统的其他疾病除2004、2005、2011、2012年外,其余年份间差异均有统计学意义（P<0.05）。性别死亡率：各年份风湿热和风湿性心脏病、缺血性心脏病和脑血管病死亡率性别差异均有统计学意义（P<0.05）,循环系统的其他疾病除2005年外,其余各年性别差异有统计学意义（P<0.05）,高血压心脏病/肾脏病死亡率仅2005年和2015年性别差异有统计学意义（P<0.05）。地区别死亡率：各年份各类别疾病死亡率地区别差异均有统计学意义（P<0.05）。 结论 循环系统疾病死亡率具有明显的城乡别、性别、地区别差异。缺血性心脏病城市高发,其他各类疾病乡村高发;女性风湿热和风湿性心脏病高发,其他各类疾病均为男性高发;风湿热和风湿性心脏病、高血压心脏病/肾脏病、缺血性心脏病、脑血管病、循环系统的其他疾病死亡率地区别差异明显,应根据地区别的差异确定不同的循环系统疾病的防治重点和采取不同的防治措施。 该文的微信推文请扫描下方二维码查看！     

Etiological pattern of atrial fibrillation

An attempt to find out the causes of atrial fibrillation was made in this study; although this does not represent total picture of whole population as the number of cases was limited and taken from a particular area for a limited period. Among the causes in our country, rheumatic mitral valvular disease topped the list followed by rheumatic multiple valvular disease IHD, HHD; lone atrial fibrillation came in the aetiology sequentially. This information is valuable in regard to management as rheumatic heart disease, the prime cause of atrial fibrillation in our country.