Arrhythmias in rheumatic heart diseases patients

Abstract

Introduction: In recent decades the rheumatism is decreasing. The number of patients affected by rheumatic heart disease failure in the world reaches 15.6 million, and annually are registered about 470000 new cases.The rhythm disturbance is common in these patients. The atrialfibrillation is described in medical literature as the most frequent arrhythmia in patients with mitral valve involvement. In mitral stenosis the prevalence of atrial fibrillation increases with age. It is known that the atrial fibrillation is present in 10% of patients aged up to 30 years, while the age over 50 years its reaches till 50% cases. Objectives: To analyze the characteristics of arrhythmia in rheumatic heart disease at patients hospitalized in the Institute of Cardiology from Republic of Moldova. Methods: In the study where included 24 patients with defined diagnosis of rheumatic heart disease, 18 (75%) men and 6 (25%) women, median age 58 years old (range 41-75), 12 (50%) patients with mitral valve disease, 7 (29.1%) patients with aortalvalve disease, and 5 (20.8%) patients with associated involvement. We analyzed the patients’ complaints, disease history, and the results of the clinical and laboratory examination, the Electrocardiography (ECG) in the resting position, transthoracicechocardiography (EcoCG), Doppler EcoCG. Results: In the study group were prevailed patients from countryside-16 (66.6%) patients versus 8 (33.3%) patients from urban space. The data analysis showed that V2 (50%) of the patients suffered acute rheumatic fever in childhood (ARF). The common complaints at admission were dyspnea in 20 (83.3%) cases, peripheral edema at 15(62.5%), patients with syncope 3 (12.5%). The ECG evaluation showed the atrial fibrillation (AF) at 16 (66.6%) patients, included 7 (29.1%) with chronic atrial fibrillationform and4 (16.6%) patients hadatrial paroxysmal fibrillation. Theatrial flutter and the extrasystolies where found less 3 (12.5%) and 2 (8.3%) patientsrespectively. The conductibility disturbance certified in 9 (37.5%) patients, including left branch block5 (20.8%) patients, rightbranch block3 (12.5%) patients, and the atrio-ventricular block 1 (4.16%) patient. TheEcoCG analysis confirmed the structural changes on valves: mitral valve stenosisin 8 (33.3%) patients, mitral valve regurgitation with different degrees- 4 (16.6%) patients, aortic orifice stenosis-4 (16.6%)patients, and the aortic regurgitation- 3 (12.5%) patients, the tricuspid valve regurgitation in 3 (12.5%) patients.The cardiomegaly has been found in 13 (54.1%) patients, more frequently left atrium dilatation at 9 (37.5%) patients. Conclusion: The atrial fibrillation was the most frequent arrhythmias in our study group certified at 2/3 of patients, predominantly chronic form at patient with mitral valve involvement.