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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
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Subclinical ventricular dysfunction in rheumatoid arthritis.

Patrícia Rodrigues1,2,3,4, Betânia Ferreira5,6,7, Tomás Fonseca8

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Rheumatoid arthritis patients often have undiagnosed heart dysfunction. Echocardiography screening can detect subclinical ventricular dysfunction, particularly in older individuals with RA.

Keywords:
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Area of Science:

  • Cardiology
  • Rheumatology
  • Medical Imaging

Background:

  • Patients with rheumatoid arthritis (RA) face elevated risks for underdiagnosed heart failure.
  • Current echocardiographic screening recommendations for heart failure in RA patients are lacking.
  • Subclinical ventricular dysfunction may be prevalent in RA patients without known heart disease.

Purpose of the Study:

  • To determine the prevalence of subclinical ventricular dysfunction in RA patients using current echocardiographic guidelines.
  • To investigate the association of ventricular dysfunction with patient characteristics, biomarkers, and prognostic parameters.
  • To compare the 2016 echocardiographic guidelines with the 2009 recommendations.

Main Methods:

  • Prospective study involving RA patients without pre-existing heart disease.
  • Classification of ventricular function into preserved ventricular function (PVF), systolic dysfunction (SD), isolated diastolic dysfunction (DD), or indeterminate diastolic function (IDF) based on 2016 guidelines.
  • Assessment for any ventricular dysfunction (AVD), encompassing SD, DD, and IDF.

Main Results:

  • 17% of RA patients without known cardiovascular disease exhibited subclinical systolic or diastolic dysfunction.
  • AVD was more prevalent in older RA patients (≥57 years), those with hypertension, and dyslipidemia.
  • AVD correlated with elevated NT-proBNP levels and reduced 6-minute walk test distance.
  • No significant independent associations were found between RA disease characteristics and ventricular function.

Conclusions:

  • Subclinical ventricular dysfunction is present in a notable percentage of RA patients.
  • Older age is an independent predictor of ventricular dysfunction in RA.
  • Echocardiographic screening holds potential clinical value for identifying subclinical ventricular dysfunction in RA, especially in older patients.