STUDIES ON THE AGING HEART. I. THE PATTERN OF RHEUMATIC HEART DISEASE IN OLD AGE (A CLINICAL-PATHOLOGICAL STUDY)

Abstract

50 of 263 successive autopsied cases in the 40- to 81-yr. age group had rheumatic heart disease (19%). Correlation between autopsy and clinical findings was made in regards to the tallying of structural and functional changes, diagnosis, cause of death, duration of rheumatic fever, presence of rheumatic activity, and congestive failure. Roentgen-ray, ecg., blood count, sediment rate findings, and the evaluation of heart murmurs were critically analyzed and correlated with autopsy findings. Correct diagnosis of rheumatic heart disease and the valves involved was made in 84% of the more advanced cases, and in 62% of those with minor lesions. Errors in diagnosis are made because history, physical findings (especially heart murmurs), X-rays, and ecg''s., are not properly evaluated, or because evidence in this age group is frequently evasive if not diligently searched for. In 31 of the 50 cases, congestive heart failure was the chief cause of death. Rheumatic activity was found clinically in 16, and by autopsy in 4 additional cases. Pathologic lesions in liver were found clinically in 76%, at necropsy in 86%. Significant pulmonary complications, aside from congestion, were found in 36%. Rheumatic fever is a more frequent etiological factor in heart disease, in congestive heart failure, and as a cause of death in old age than generally recognized. Evidence presented also indicates the little realized importance of initial attacks of rheumatic fever, and of clinical rheumatic activity in this age group.