Title : Electrocardiographic findings in rheumatic heart disease
Abstract:
Rheumatic heart disease is a major public health burden, especially in children of developing nations.
Electrocardiographic screening has revealed that the burden of disease is higher than expected, and
subclinical cases are manifold higher than clinical cases. Early detection and treatment is imperative for
the most favourable outcome.
Rheumatic heart disease can be diagnosed using standard echocardiography or listened to as a heart murmur
using a stethoscope. The electrocardiogram, on the other hand, is critical in the study and identification of
heart rhythms and abnormalities.The effectiveness of electrocardiogram to identify distinguishing signs
of rheumatic heart problems, however, has not been adequately examined.
This review aims to provide a brief overview of studies conducted regarding the same and draw attention to
some abnormalities which, when present in conjunction with other clinical findings of rheumatic disease,
could be considered convincing diagnostic criteria.
Extensive electrocardiographic datasets were obtained and examined, from both children and adults, at
regular intervals.Patients with varying presentations such as subclinical rheumatic activity, quiescent
Rheumatic Heat Disease, were included.
The electrocardiograms were analysed for rate, rhythm, PR interval, ST deviation, T wave changes and the
QT duration. The results were then statistically analysed and compared with age and sex-matched healthy
control subjects.
Conventionally, auscultation has been used for diagnosing Rheumatic heart disease.Most of these studies
report an almost 10-fold higher prevalence of Rheumatic heart disease by echocardiography as compared
to conventional method of auscultation.
The most recent study conducted in 2023 has several interesting findings:
PR elongation in 47.2 percent of cases
QRS elongation in 26.4 percent of cases
QTc elongation in 44.3 percent of cases
Another study published in the British Heart Journal concluded that close to 90 percent of patients with
active Rheumatic heart disease have significant QTc elongation. Thus, the QTc interval measurement is
highly significant clinically and could be considered a diagnostic sign.
A study conducted by Dr. Harold EB Pardee in 1947, has an extensive array of thought-provoking findings.
The study suggests that nodal tachycardia and the Wenckebach phenomenon are very common appearances
and more so than auricular tachycardia. Low voltage QRS complex and increased T wave voltage may also
bear some significance. Increased sedimentation rate was also seen for relatively prolonged periods of
time.
Shreenithi J
Stanley Medical College, Chennai, India
DAY
02
105
An exclusive study on children conducted by Dr.Henry Crossfield, found that a PR interval greater than 0.16
seconds should serve as a sign for active disease. Rheumatic heart disease in children also commonly causes
large, pointed, broad-base P2 waves in children, while advanced cases may show ST segment depression.
Both the above studies found inverted or diphasic T waves in leads I or II or both.
Significant clinical findings in electrocardiography are several times higher than findings in clinical
examination. This highlights the importance of electrocardiographic screening and further research to
establish standardized criteria, like that defined by the World Heart Federation. The end product of this
research can lead to new medical devices and services which could assist in the detection and diagnosis of
the disease in low-resource settings and alleviate the burden of the disease.
Audience Take Away Notes
• Commonly found changes in rate, rhythm, waves and segments of electrocardiograms of patients with
Rheumatic heart disease
• Prevalence and the clinical significance of the findings
• This review will update the audience about the progress made so far in this regard, and the questions
that need to be answered in the future.
• The importance of widespread screening and establishment of standard criteria for diagnosis
