title: Clinical Evaluation Versus Echocardiography in the Assessment of Rheumatic Heart Disease.
abstract: BACKGROUND
  Rheumatic heart disease (RHD) is still a common form of heart disease among children and young adults, especially in developing countries like India. Between 1940 and 1983, the prevalence rate of RHD varied from 1.8 to 11 per 1000 (national average 6 per 1000), while between 1984 and 1995 the rate varied from 1 to 5.4 per 1000 [1]. The study was carried out to assess the accuracy of a medical student's clinical evaluation of valvular heart disease and compare it with that of an echocardiographic evaluation and to determine the sensitivity, specificity and predictive values of clinical examination as compared to echocardiography for the various lesions in RHD patients.
  
  
  METHODS
  50 children between the ages of 5-16 years, attending the out patient department or admitted in a large teaching hospital, satisfying the criteria of RHD, were included in the study. Each patient underwent detailed clinical evaluation and relevant investigations including echocardiography.
  
  
  RESULTS
  Mitral valve was involved most often both by echocardiography and clinically. Isolated aortic valve involvement was rare. The most common lesion was mitral regurgitation (MR) both by auscultation and by echo. Mixed lesions were seen more often than pure lesions. Mitral stenosis (MS) had the highest sensitivity while tricuspid regurgitation (TR) had the highest specificity. MR had the highest positive predictive value and MS the highest negative predictive value. Sensitivity and specificity of aortic regurgitation (AR) was very low when compared to earlier studies. There was a statistically significant difference between echo diagnosis and clinical diagnosis (p < 0.05).
  
  
  CONCLUSIONS
  It is recommended that echocardiography be done routinely for the diagnosis of cardiac lesions in patients of RHD as clinical examination alone can miss various lesions, especially when the lesions are mild or when multiple lesions are present.
authors.affiliation: Ex-Medical Cadet, Department of Paediatrics, Armed Forces Medical College, Pune-411 040.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Reddy
authors.affiliation: Associate Professor, Department of Paediatrics, Armed Forces Medical College, Pune-411 040.
authors.forename: S K
authors.initials: SK
authors.lastname: Jatana
authors.affiliation: Professor & Head, Department of Paediatrics, Armed Forces Medical College, Pune-411 040.
authors.forename: Mng
authors.initials: M
authors.lastname: Nair
keywords: Aortic valve; Children; Mitral valve; Rheumatic heart disease; Tricuspid valve