Rheumatic Heart Disease, Aortitis, Miscellaneous Cardiovascular Diseases

Abstract

There is overwhelming evidence that rheumatic heart disease is today the commonest form of heart disease in children and young adults in most tropical or developing countries, and one of the most common cardiovascular diseases in adults (Shaper 1972). Not only is it common but there is clinical and necropsy evidence from several countries that the frequency of the disease is increasing. In almost all tropical studies on acute rheumatic fever, the proportion of very young children affected is regarded as higher than in temperate climates. In Johannesburg, when African children were compared with American and British children, the African group showed twice the percentage of children under five years of age (Chesler et al. 1966) and many children under ten years of age have severe valvular disease. Thus, tropical rheumatic fever affects the younger age group, and the severity, as measured by early mortality, is greater than in temperate countries. Acute rheumatic fever exists in a virulent form in Blacks because of the youth of the patients and the frequency of carditis and congestive cardiac failure, and a higher proportion of deaths in the younger age groups (Schrire 1958; Chesler et al. 1966). Schwartz et al. (1958) showed that acute and chronic rheumatic heart disease accounted for 23.3% of the cases of heart disease admitted to one of the medical wards at Baragwanath Hospital and was second in frequency only to idiopathic cardiomyopathy. The high incidence of rheumatic heart disease in Blacks can be equated with a high prevalence of streptococcal infection and its consequences, which are among the many schedules of poverty, one of the many afflictions that can be rooted out by socio-economic amelioration (Spodick 1975). In the necropsy series of Higginson et al. (1960) rheumatic heart disease accounted for 32.5% of all cardiac deaths and was thus the commonest cardiac disease at postmortem.