A clinical study of Rheumatic Valvular Heart Disease in patients above forty years of age admitted in Assam Medical College and Hospital, Dibrugarh

BackgroundIt is thought uncommon for Rheumatic Heart Disease (RHD) to present in the 5th decade or later with their first symptom. Only few studies are available on RHD in elderly.AimTo study the clinical profile of RHD in patients above 40 years of age presenting for the first time.Methods and materialAll patients aged 40 years and above, presenting for the first time with clinical features of RHD during a period of one year from May 2011 to April 2012, were studied. Other valvular heart diseases of non-rheumatic origin and congenital valvular heart diseases were excluded from the study. Patients were then evaluated with detailed history, clinical examination, electrocardiography, chest x-ray and echocardiography and relevant blood investigations.ResultsA total of 42 cases were enrolled in the present study. Most of patients presented with exertional dyspnea (38.1%), orthopnea (19.05%) and palpitation (35.71%). Atrial fibrillation (AF) was found in 64.29%, cerebrovascular accident (CVA) in 26.19%, congestive cardiac failure (CCF) in 16.67% and infective endocarditis (IE) in 9.52%. Isolated Mitral Stenosis (MS) was the most common valvular lesion, observed in 47.62% cases. Surprisingly, all the female patients did not have any cardiovascular symptoms during their pregnancies.ConclusionThis study revealed that a large number of patients of RHD presenting for the first time are elderly. Even the female patients were asymptomatic during their previous pregnancies. Complications were fairly common at presentation. The factors which could be responsible for these need evaluation. Burden of RHD in elderly also need estimation.