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Sumitr Sutra - One of the best experts on this subject based on the ideXlab platform.
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The relationship of Carditis to the initial attack of Sydenham's chorea.
International Journal of Cardiology, 2004Co-Authors: Manat Panamonta, Arnkisa Chaikitpinyo, Edward L Kaplan, Aunejit Pantongwiriyakul, Sompon Tassniyom, Sumitr SutraAbstract:Abstract Background : The natural history of valvular regurgitation detected by echocardiography in Sydenham's chorea has been lacking. Methods : Clinical assessment and transthoracic color Doppler echocardiography were independently performed for each patient with an initial attack of Sydenham's chorea and also for each normal control (Khon Kaen University, Thailand; 1991–2001) at the time of their presentations. Serial clinical examinations and echocardiography were done for each patient at 1- and at 5-year follow-up. Results : Of 44 patients, 17 (39%) had Carditis (valvulitis) evident by auscultation at the time of the initial attack. Three (11%) of the 27 patients with no clinical evidence of Carditis had echocardiographic evidence of acute mitral regurgitation (subclinical valvulitis). All 17 patients with Carditis had echocardiographic evidence of acute mitral regurgitation. None of the 88 control children had evidence of pathologically significant valvular regurgitation. Of the 15 patients with Carditis regularly followed, the persistence of a mitral regurgitation murmur and of pathologically significant valvular regurgitation by echocardiography were 33% (5/15) and 60% (9/15), respectively, at 1-year follow-up, but the persistence of both was 25% (1/4) at 5-year follow-up. Conclusions : Color Doppler echocardiography is a useful tool in the early diagnosis of rheumatic Carditis (valvulitis) and at 1-year follow-up of rheumatic valvular heart disease in the patients with initial Sydenham's chorea but the incremental benefit beyond 5 years after the initial attack might be minimal.
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The relationship of Carditis to the initial attack of Sydenham's chorea.
International journal of cardiology, 2004Co-Authors: Manat Panamonta, Arnkisa Chaikitpinyo, Edward L Kaplan, Aunejit Pantongwiriyakul, Sompon Tassniyom, Sumitr SutraAbstract:The natural history of valvular regurgitation detected by echocardiography in Sydenham's chorea has been lacking. Clinical assessment and transthoracic color Doppler echocardiography were independently performed for each patient with an initial attack of Sydenham's chorea and also for each normal control (Khon Kaen University, Thailand; 1991-2001) at the time of their presentations. Serial clinical examinations and echocardiography were done for each patient at 1- and at 5-year follow-up. Of 44 patients, 17 (39%) had Carditis (valvulitis) evident by auscultation at the time of the initial attack. Three (11%) of the 27 patients with no clinical evidence of Carditis had echocardiographic evidence of acute mitral regurgitation (subclinical valvulitis). All 17 patients with Carditis had echocardiographic evidence of acute mitral regurgitation. None of the 88 control children had evidence of pathologically significant valvular regurgitation. Of the 15 patients with Carditis regularly followed, the persistence of a mitral regurgitation murmur and of pathologically significant valvular regurgitation by echocardiography were 33% (5/15) and 60% (9/15), respectively, at 1-year follow-up, but the persistence of both was 25% (1/4) at 5-year follow-up. Color Doppler echocardiography is a useful tool in the early diagnosis of rheumatic Carditis (valvulitis) and at 1-year follow-up of rheumatic valvular heart disease in the patients with initial Sydenham's chorea but the incremental benefit beyond 5 years after the initial attack might be minimal.
Jagat Narula - One of the best experts on this subject based on the ideXlab platform.
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Diagnosis of active rheumatic Carditis. The echoes of change.
Circulation, 1999Co-Authors: Jagat Narula, Y. Chandrasekhar, Shahbudin H. RahimtoolaAbstract:Not everything that counts can be counted, and not everything that can be counted counts . Albert Einstein Acute rheumatic fever (RF) continues to be a major health problem at the dawn of the new millennium in many parts of the world.1 2 3 Rheumatic heart disease (RHD), the sequel of RF, is a very common cause of cardiovascular mortality and morbidity,1 2 3 4 5 accounts for 35% to 40% of cardiovascular disease-related hospital admissions, and is the predominant indication for cardiac surgery in developing countries.1 6 Although traditionally considered to be a disease associated with poverty and overcrowding, RF continues to persist, even among the prosperous middle-class population in developed countries.7 8 9 Although RF is a systemic disease with multiorgan involvement, none of its manifestations, except for Carditis, lead to permanent damage. Clinical cardiac involvement has been reported in nearly one-third to almost all patients with RF in various series and in up to 50% of patients in prospective studies.10 Detection of active rheumatic Carditis is of great prognostic and therapeutic importance and is currently based on the Jones criteria. Not infrequently, the diagnosis of Carditis by the Jones criteria becomes difficult, especially when Carditis is the isolated manifestation of the disease or when the rheumatic activity occurs on preexisting RHD.11 12 13 It is important to develop a diagnostic strategy that will improve our ability to diagnose rheumatic Carditis and allow us to apply existing criteria more efficiently.13 14 The advent of modern, highly sensitive cardiac imaging modalities, predominantly echocardiography/Doppler ultrasound (echo-Doppler), has raised the question whether the Jones criteria should be modified to incorporate these techniques. ### Clinical Diagnosis of RF and Carditis The Jones criteria were introduced in 1944 as a set of clinical guidelines for the diagnosis of RF.15 The manifestations of …
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Echocardiographic Evaluation of Patients With Acute Rheumatic Fever and Rheumatic Carditis
Circulation, 1996Co-Authors: Ramachandran S. Vasan, Savitri Shrivastava, Manam Vijayakumar, Rajiv Narang, Bradford C. Lister, Jagat NarulaAbstract:Background Cardiac involvement is the most important component of acute rheumatic fever. The role of echocardiography in the evaluation of rheumatic Carditis has not been adequately defined. We used echocardiography in a large sample of patients with acute rheumatic fever to describe morphological abnormalities associated with rheumatic Carditis and to assess its role in the diagnosis of rheumatic Carditis. Methods and Results Cross-sectional and color Doppler echocardiographic examination was performed in 108 consecutive patients with acute rheumatic fever within 24 to 48 hours of diagnosis. Twenty-eight patients had acute rheumatic fever without clinical evidence of Carditis (group 1). Thirty-five patients had a presumed first episode of rheumatic Carditis (group 2), and 45 patients had a recurrence of Carditis (group 3). Patients in group 1 did not demonstrate any evidence of valvular regurgitation. Mitral regurgitation was the most common Doppler echocardiographic feature in groups 2 (94%) and 3 (84%)...
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does endomyocardial biopsy aid in the diagnosis of active rheumatic Carditis
Circulation, 1993Co-Authors: Jagat Narula, Ramachandran S. Vasan, P Chopra, K K Talwar, K S Reddy, M L Bhatia, R K Tandon, J F SouthernAbstract:BACKGROUNDCarditis is the only component of rheumatic fever that leads to permanent disability. The diagnosis of Carditis is presently made by using composite clinical criteria based on the revised Jones' criteria. Since myocardial involvement is an important component of rheumatic Carditis, right ventricular endomyocardial biopsies were performed in 54 patients with clinical acute rheumatic fever and quiescent rheumatic heart disease to evaluate the role of biopsy for the diagnosis of rheumatic Carditis.METHODS AND RESULTSIn 11 of the 54 patients, clinical consensus was certain about rheumatic fever and Carditis based on the revised Jones' criteria (group 1). Histomorphological abnormalities in these patients were scarce. The diagnostic features of rheumatic myoCarditis including Aschoff nodules or histiocytic aggregates were encountered in 3 patients (27%). Lymphocytic infiltration was sparse. A majority of patients demonstrated myocyte degeneration, interstitial degeneration, or occasional interstitial...
Francisco Valdes - One of the best experts on this subject based on the ideXlab platform.
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prospective comparison of clinical and echocardiographic diagnosis of rheumatic Carditis long term follow up of patients with subclinical disease
Heart, 2001Co-Authors: F E Figueroa, Soledad M Fernandez, Perez Calixto Valdes, C Wilson, Fernando Lanas, Flavio Carrion, X Berrios, Francisco ValdesAbstract:Objective—To determine the frequency of occurrence and long term evolution of subclinical Carditis in patients with acute rheumatic fever. Design—Valvar incompetence was detected by clinical examination and Doppler echocardiographic imaging during the acute and quiescent phases of rheumatic fever. Patients were followed prospectively and submitted to repeat examinations at one and five years after the acute attack. Persistence of acute mitral and aortic lesions detected solely by echocardiography (subclinical disease) was compared with that of disease detected by clinical examination as well (thereby fulfilling the latest 1992 Jones criteria for rheumatic Carditis). Setting—Three general hospitals with a university aYliation in Chile. Patients—35 consecutive patients fulfilling the revised Jones criteria for rheumatic fever. Clinical and echocardiographic examination was repeated in 32 patients after one year and in 17 after five years. Ten patients had subclinical Carditis on admission, six of whom were followed for five years. Main outcome measures—Auscultatory and echocardiographic evidence of mitral or aortic regurgitation during the acute attack or at follow up. Results—Mitral or aortic regurgitation was detected by Doppler echocardiographic imaging in 25/35 rheumatic fever patients as opposed to 5/35 by clinical examination (p = 0.03). Doppler echocardiography revealed acute valvar lesions in 10 of 20 rheumatic fever patients who had no auscultatory evidence of rheumatic Carditis (subclinical Carditis). Three of these subclinical lesions and three of the clinical or auscultatory lesions detected on admission were still present after five years of follow up, emphasising that subclinical lesions are not necessarily transient. Conclusions—Doppler echocardiographic imaging improves the detection of rheumatic Carditis. Subclinical valve lesions, detected only by Doppler imaging, can persist. Echocardiographic findings should be accepted as a major criterion for the diagnosis of rheumatic fever. (Heart 2001;85:407‐410)
Nazmi Narin - One of the best experts on this subject based on the ideXlab platform.
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Plasma gelsolin as a biomarker of acute rheumatic Carditis.
Cardiology in the young, 2014Co-Authors: Mustafa Argun, Ozge Pamukcu, Abdullah Ozyurt, Ali Baykan, Kazım Üzüm, Figen Narin, Ferhan Elmali, Nazmi NarinAbstract:Background Acute rheumatic fever is an autoimmune, inflammatory, and multi-systemic disease secondary to pharyngitis and is caused by group A streptococcus. In developing countries, acute rheumatic fever is the most common cause of acquired heart disease. Gelsolin is a calcium-dependent, multi-functional actin-regulatory protein circulating in the plasma of healthy human beings. The correlation between blood gelsolin levels and inflammatory conditions suggests the potential benefit of gelsolin as a prognostic marker. The aim of the present study was to appraise the association of gelsolin and acute rheumatic Carditis in childhood. Materials and methods Plasma gelsolin levels were measured and echocardiographic examinations were performed in patients (n=37) with acute rheumatic Carditis and compared with those of age- and gender-matched healthy controls (n=24). Results The plasma gelsolin levels in children with acute rheumatic Carditis were significantly lower compared with controls (197±218 versus 322±255 mg/L, p=0.039). There was a significant correlation among gelsolin levels and the grade of mitral regurgitation (p=0.030), left ventricular end-diastolic diameter (p=0.017), and left ventricular end-systolic diameter (p=0.028) at diagnosis. Conclusions Levels of the gelsolin plasma isoform were decreased in patients with acute rheumatic Carditis compared with healthy controls. Gelsolin may be used as a biochemical marker for acute rheumatic Carditis.
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Importance of N-terminal pro-brain natriuretic peptide in monitoring acute rheumatic Carditis.
Cardiology in The Young, 2013Co-Authors: Feyza Esen, Mustafa Argun, Ozge Pamukcu, Abdullah Ozyurt, Ali Baykan, Sadettin Sezer, Zeynep Baykan, Kazım Üzüm, Nazmi NarinAbstract:PURPOSE: To detect the relationship of N-terminal pro-brain natriuretic peptide levels with clinical and laboratory findings by measuring them at diagnosis, during, and after treatment in children with acute rheumatic Carditis. METHOD: A total of 40 children including 20 acute rheumatic Carditis patients aged between 5 and 16 years 20 healthy children as controls were included in the study. Blood was drawn from patients at diagnosis and in the first week, first month and third month after treatment in order to detect pro-brain natriuretic peptide, C-reactive protein levels and erythrocyte sedimentation rates. All patients underwent echocardiography. RESULTS: The N-terminal pro-brain natriuretic peptide levels of children with acute rheumatic Carditis were significantly higher than those of the control group at diagnosis and during treatment (p
Joseph D Forrester - One of the best experts on this subject based on the ideXlab platform.
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notes from the field update on lyme Carditis groups at high risk and frequency of associated sudden cardiac death united states
Morbidity and Mortality Weekly Report, 2014Co-Authors: Joseph D Forrester, J Meiman, J Mullins, Randall S Nelson, S H Ertel, Matthew L Cartter, Catherine M Brown, E Schiffman, David F Neitzel, Elizabeth R DalyAbstract:On December 13, 2013, MMWR published a report describing three cases of sudden cardiac death associated with Lyme Carditis. State public health departments and CDC conducted a follow-up investigation to determine 1) whether Carditis was disproportionately common among certain demographic groups of patients diagnosed with Lyme disease, 2) the frequency of death among patients diagnosed with Lyme disease and Lyme Carditis, and 3) whether any additional deaths potentially attributable to Lyme Carditis could be identified. Lyme disease cases are reported to CDC through the Nationally Notifiable Disease Surveillance System; reporting of clinical features, including Lyme Carditis, is optional. For surveillance purposes, Lyme Carditis is defined as acute second-degree or third-degree atrioventricular conduction block accompanying a diagnosis of Lyme disease. During 2001-2010, a total of 256,373 Lyme disease case reports were submitted to CDC, of which 174,385 (68%) included clinical information. Among these, 1,876 (1.1%) were identified as cases of Lyme Carditis. Median age of patients with Lyme Carditis was 43 years (range = 1-99 years); 1,209 (65%) of the patients were male, which is disproportionately larger than the male proportion among patients with other clinical manifestations (p<0.001). Of cases with this information available, 69% were diagnosed during the months of June-August, and 42% patients had an accompanying erythema migrans, a characteristic rash. Relative to patients aged 55-59 years, Carditis was more common among men aged 20-39 years, women aged 25-29 years, and persons aged ≥75 years.
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third degree heart block associated with lyme Carditis review of published cases
Clinical Infectious Diseases, 2014Co-Authors: Joseph D Forrester, Paul S MeadAbstract:Lyme Carditis is an uncommon manifestation of Lyme disease that most commonly involves some degree of atrioventricular conduction blockade. Third-degree conduction block is the most severe form and can be fatal if untreated. Systematic review of the medical literature identified 45 published cases of third-degree conduction block associated with Lyme Carditis in the United States. Median patient age was 32 years, 84% of patients were male, and 39% required temporary pacing. Recognizing patient groups more likely to develop third-degree heart block associated with Lyme Carditis is essential to providing prompt and appropriate therapy.