Tiger Stripes in Carditis of Rheumatic Origin

Area of Science:

• Cardiology
• Medical Imaging
• Rheumatology

Background:

• Rheumatic heart disease (RHD) remains a significant global health concern, often leading to valvular complications.
• Doppler echocardiography is crucial for assessing cardiac function and identifying valvular abnormalities in RHD.
• The "Tiger stripes" or "Zebra stripes" sign on Doppler spectral recordings has been linked to various intracardiac oscillating structures.

Observation:

• A case of a 14-year-old boy with RHD presenting with dyspnea and elevated inflammatory markers.
• Echocardiography revealed severe mitral regurgitation with characteristic "tiger stripes" on continuous wave (CW) Doppler.
• The presence and resolution of these signals correlated with steroid treatment, indicating active valvulitis.

Findings:

• The study proposes that the observed high-intensity signals, termed the "Fingerprint sign," reflect active valvulitis in RHD.
• This sign is suggested to be the echocardiographic manifestation of musical overtones associated with dynamic valvular oscillations.
• The "Fingerprint sign" demonstrated a dynamic nature, reappearing upon steroid tapering and symptom exacerbation.

Implications:

• The "Fingerprint sign" can serve as a valuable echocardiographic marker for identifying and monitoring carditis in RHD patients.
• Its presence warrants appropriate management of active carditis, including steroid therapy.
• This sign offers a novel approach to assessing disease activity and guiding therapeutic decisions in rheumatic carditis.