{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T11:36:11Z","timestamp":1790940971654,"version":"4.1.0"},"reference-count":14,"publisher":"S. Karger AG","issue":"8","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiology"],"published-print":{"date-parts":[[2020]]},"abstract":"<b><i>Background:<\/i><\/b> Acute rheumatic fever (ARF) and acute rheumatic carditis (ARC) continue to be a major public health problem in developing countries. <b><i>Objective:<\/i><\/b> To study the characteristics of children with ARC being treated at a tertiary centre. <b><i>Methods and Results:<\/i><\/b> We studied 126 children (mean age 10.4 \u00b1 2.3 years, range 5\u201315 years, 60% males) diagnosed with ARC by treating cardiologists. Most had lower socio-economic status. Fifty of 126 (40%) presented with a first episode of ARC. Joint symptoms were present in 29% and fever in 25%. Only 2.4% had subcutaneous nodules and none had erythema marginatum or chorea. Fifty-one percent presented in NYHA class II and 29% in NYHA class III or IV. Tachycardia and heart failure were present in 53% and 21%, respectively. Recent worsening of NYHA class (dyspnoea) was the commonest feature (48%). Laboratory investigations showed raised antistreptolysin O titres (&#x3e;333 units) in only 36.7% of patients. Raised C-reactive protein (CRP) was present in 70%, while raised erythrocyte sedimentation rate was found in only 37% of patients. On the basis of above findings, the modified Jones criteria (2015) for the diagnosis of ARF were satisfied only in 46% of children. Echocardiography showed mitral valve thickening in 77% and small nodules on the tip of the leaflets in 43% (27 and 8%, respectively for aortic valve). Left ventricular ejection fraction was &#x3c;50% in only 3 patients. The dominant valve lesion was mitral regurgitation (MR) (present in 95% of patients; severe in 78%, moderate in 15%), while aortic regurgitation was present in 44% (severe in 14%). <b><i>Conclusions:<\/i><\/b> The criteria are often not satisfied by patients being treated for ARC. Recent unexplained worsening of dyspnoea, young age, significant MR, echocardiographic nodules, and elevated CRP are important indicators. <\/jats:p>","DOI":"10.1159\/000508035","type":"journal-article","created":{"date-parts":[[2020,6,11]],"date-time":"2020-06-11T21:00:33Z","timestamp":1591909233000},"page":"522-528","source":"Crossref","is-referenced-by-count":4,"title":["Characteristics of Children with Acute Rheumatic Carditis from a High-Incidence Region: Importance of Unexplained Worsening of Functional Class"],"prefix":"10.1159","volume":"145","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9634-5887","authenticated-orcid":false,"given":"Rajiv","family":"Narang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Saxena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivasubramanian","family":"Ramakrishnan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurabh\u00a0K.","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajnish","family":"Juneja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyam\u00a0S.","family":"Kothari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2020,6,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001477"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-300792"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.09.184"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.5935\/abc.20130172"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000205"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-015-1753-z"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0006577"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA-2018-031"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199102073240601"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ihj.2017.08.017"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2013.08.007"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-008-9242-z"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.94.1.73"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.4103\/0975-3583.74260"}],"container-title":["Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/508035","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/508035","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T16:06:17Z","timestamp":1745424377000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000508035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,8,5]]},"published-print":{"date-parts":[[2020,8,11]]}},"URL":"https:\/\/doi.org\/10.1159\/000508035","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.12463955","asserted-by":"subject"}]},"ISSN":["0008-6312","1421-9751"],"issn-type":[{"value":"0008-6312","type":"print"},{"value":"1421-9751","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020]]}}}