The emergence of cardiac nondisease among children in Iran.

In a prospective study over a one-year period, 476 new patients, aged three days to 21 years, were seen in a pediatric cardiology clinic held three times a week in two hospitals. Of these patients, 290 (61%) were normal; in 238 (82%) of these a physician had made a definite diagnosis of heart disease. The usual bases for a diagnosis of heart disease in these cases of "cardiac nondisease" were an "elevated" antistreptolysin O titer, growing pains, hyperventilation and functional murmurs, or a combination of these. Of these 238 cardiac nondisease patients, 188 (79%) were under active treatment for up to seven years (mean, 1.23 years). This treatment included monthy penicillin injections for 104 patients for up to seven years; restriction of physical activity in 98 patients; up to six months of aspirin therapy for 25; up to three months of bed rest for 23; steroids for 17; and 'prophylactic" tonsillectomies for 11 patients. Some patients with comfirmed heart disease (35 of 97) were receiving grossly inappropriate treatment. All this represents a significant change in the pattern of pediatric care from that which existed 10 years ago, when cardiac nondisease was nonexistent and many cases of heart disease went unrecognized and untreated. In this report, possible reasons for the emergence of cardiac nondisease are discussed.