title: Presenting features of newly diagnosed rheumatic heart disease patients in Mulago Hospital: a pilot study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Uganda Heart Institute and Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Zhang
authors.forename: Charles
authors.initials: C
authors.lastname: Mondo
authors.forename: Emmy
authors.initials: E
authors.lastname: Okello
authors.forename: Charles
authors.initials: C
authors.lastname: Musoke
authors.forename: Barbara
authors.initials: B
authors.lastname: Kakande
authors.forename: Wilson
authors.initials: W
authors.lastname: Nyakoojo
authors.forename: James
authors.initials: J
authors.lastname: Kayima
authors.forename: Jurgen
authors.initials: J
authors.lastname: Freers
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004617:Embolism / Q000175:diagnosis / Q000209:etiology*; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology*; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology*; D006785:Hospitals, University; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D010865:Pilot Projects; D011379:Prognosis; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000175:diagnosis; D011795:Surveys and Questionnaires; D013997:Time Factors; D014454:Uganda; D055815:Young Adult