Zhang Wanzhu, Mondo Charles, Okello Emmy, Musoke Charles, Kakande Barbara, Nyakoojo Wilson, Kayima James, Freers Jurgen
Uganda Heart Institute and Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Cardiovasc J Afr. 2013 Mar;24(2):28-33. doi: 10.5830/CVJA-2012-076.
Rheumatic heart disease (RHD) continues to cause gross distortions of the heart and the associated complications of heart failure and thromboembolic phenomena in this age of numerous high-efficacy drugs and therapeutic interventions. Due to the lack of contemporary local data, there is no national strategy for the control and eradication of the disease in Uganda. This study aimed to describe the presenting clinical features of newly diagnosed patients with RHD, with particular reference to the frequency of serious complications (atrial fibrillation, systemic embolism, heart failure and pulmonary hypertension) in the study group.
One hundred and thirty consecutive patients who satisfied the inclusion criteria were recruited over a period of eight months from June 2011 to January 2012 at the Mulago Hospital, Uganda. Data on demographic characteristics, disease severity and presence of complications were collected by means of a standardised questionnaire.
Seventy-one per cent of the patients were female with a median age of 33 years. The peak age of the study group was 20 to 39 years, with the commonest presenting symptoms being palpitations, fatigue, chest pain and dyspnoea. The majority of the patients presented with moderate-to-severe valvular disease. Pure mitral regurgitation was the commonest valvular disease (40.2%), followed by mitral regurgitation plus aortic regurgitation (29%). Mitral regurgitation plus aortic regurgitation plus mitral stenosis was found in 11% of patients. There was only one case involving the tricuspid valve. The pulmonary valves were not affected in all patients; 45.9% of patients presented in severe heart failure in NYHA class III/IV, 53.3% had pulmonary hypertension, 13.9% had atrial fibrillation and 8.2% had infective endocarditis. All patients presented with dilated atria (> 49 mm).
A significant proportion of RHD patients present to hospital with severe disease associated with severe complications of advanced heart failure, pulmonary hypertension, infective endocarditis and atrial fibrillation. There is a need to improve awareness of the disease among the population, and clinical suspicion in primary health workers, so that early referral to specialist management can be done before severe damage to the heart ensues.
在这个拥有众多高效药物和治疗干预手段的时代，风湿性心脏病（RHD）仍会导致心脏严重变形以及心力衰竭和血栓栓塞现象等相关并发症。由于缺乏当代本地数据，乌干达没有控制和根除该疾病的国家战略。本研究旨在描述新诊断的风湿性心脏病患者的临床表现特征，特别提及研究组中严重并发症（心房颤动、系统性栓塞、心力衰竭和肺动脉高压）的发生频率。
2011年6月至2012年1月期间，在乌干达穆拉戈医院连续招募了130名符合纳入标准的患者。通过标准化问卷收集人口统计学特征、疾病严重程度和并发症情况的数据。
71%的患者为女性，中位年龄为33岁。研究组的高峰年龄为20至39岁，最常见的症状为心悸、疲劳、胸痛和呼吸困难。大多数患者表现为中重度瓣膜病。单纯二尖瓣反流是最常见的瓣膜病（40.2%），其次是二尖瓣反流加主动脉反流（29%）。11%的患者存在二尖瓣反流加主动脉反流加二尖瓣狭窄。仅1例涉及三尖瓣。所有患者的肺动脉瓣均未受影响；45.9%的患者表现为纽约心脏协会（NYHA）III/IV级严重心力衰竭，53.3%有肺动脉高压，13.9%有心房颤动，8.2%有感染性心内膜炎。所有患者均表现为心房扩大（>49mm）。
相当一部分风湿性心脏病患者因严重疾病合并晚期心力衰竭、肺动脉高压、感染性心内膜炎和心房颤动等严重并发症而住院。有必要提高公众对该疾病的认识以及基层医护人员的临床怀疑意识，以便在心脏受到严重损害之前尽早转诊至专科治疗。
