Heart rate variability in Egyptian children with acute rheumatic fever

AbstractObjectiveAcute rheumatic fever is a systemic inflammatory disease occurring after acute streptococcal tonsillopharyngitis. The PR prolongation in these patients is thought to be due to increased vagal activity. There has been no previous study investigating the autonomic balance in patients with acute rheumatic fever. In this study, we aimed to investigate the balance of the autonomic nervous system in children with acute rheumatic fever by analysis of heart rate variability.MethodsWe evaluated the heart rate variability parameters in 50 patients with acute rheumatic fever and 37 comparable control subjects. Both groups underwent 24-hour electrocardiography monitoring, and time- and frequency-domain heart rate variability parameters were calculated. A total of 39 patients (78%), with (n = 28) or without (n = 11) other major findings, had carditis, and the remaining 11 (22%) did not. The PR interval was found to be prolonged in 10 (20%) of the patients at the beginning.ResultsIn the study group, the time- and frequency-domain heart rate variability parameters showed a sympathetic dominance compared with the control group, with a p-value less than 0.05. When compared with the control group, the time- and frequency-domain heart rate variability parameters showed a significant sympathetic dominance in patients with both prolonged PR and normal PR intervals in the acute period, with a p-value less than 0.05. When compared with patients with normal PR interval, mean normalised low frequency and normalised high frequency parameters suggested a relatively lower sympathetic dominance in patients with prolonged PR interval, with a p-value less than 0.05.ConclusionOur results indicated that in the acute period of rheumatic fever, sympathetic dominance is apparent; in patients with prolonged PR interval, sympathetic dominance is relatively lower when compared with the patients with normal PR interval.

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Arthralgia in Egyptian children

QJM ◽

10.1093/qjmed/hcaa063.015 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A A Kotby ◽

N M S Soliman ◽

R M Abdelsalam

Keyword(s):

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Past History ◽

Febrile Illness ◽

Common Symptom ◽

Skeletal Deformity ◽

Benign Condition ◽

Collagen Diseases ◽

Egyptian Children ◽

Tertiary Center

Abstract Background Children presenting with joint pains are a very common occurrence in any general pediatric outpatient department. About 15% of general pediatric consultations are for myriad pains of the musculoskeletal system. Aim of the work To screen Egyptian children presenting to a tertiary center for different causes of arthralgia. Subjects and Methods This is a descriptive study that was conducted on 200 pediatric patients (86 males and 114 females) presenting with arthralgia at the Children’s hospital Ain shams University from August 2017 till April 2018. Patients with chronic illness, skeletal deformity, past history of acute rheumatic fever, and any patient with acute febrile illness were excluded. All patients were subjected to full medical history, examination, laboratory investigation as complete blood picture, erythrocyte sedimentation rate, c reactive protein, electrocardiography and echocardiography. Results Around 18% of patients with arthralgia were proved to have post streptococcal arthralgia, 35% had collagen diseases, 10% with malignant conditions. no identifiable cause could be found in 36% of the patients and two patients diagnosed as acute rheumatic fever. Conclusion Arthralgia is a common symptom in the pediatric age group. Although it is a benign condition, sometimes it accurs due to serious illness like malignancy or collagen diseases.

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