Yaws and Venereal Disease in Uganda
Authors: C. J. Hackett
Journal: BMJ (1947)

The cardiac rhythm was regular in all cases.The first mitral sound was split in 2 cases, and the intensity of this sound was diminished in 10 others, compatible with their age and varying degrees of emphysema; otherwise no abnormality was noted.However, it would be only in the incidence and character of murmurs indicative of valvular disease that a parallel between this disease and rheumatic fever could be drawn.A particularly careful search was made for evidence of early mitral stenosis, but none was found.In 8 cases a faint systolic murmur was heard at the mitral area; in all of these it was sharply localized.None of them was associated with a loud sharp first sound or with an accentuated second pulmonary sound.They were considered to be functional in origin.In one case only was there a loud mitral systolic murmur ; it did not replace the first sound but was conducted well into the axilla.This occurred in a woman of 68 who had had rheumatoid arthritis for nine years, and the signs were thought to indicate organic mitral valve disease.Electrocardiographic Findings There are, of course, no electrocardiographic abnormalities pathognomonic of rheumatic fever; the study of electrocardio- grams in rheumatoid arthritis is therefore of limited value in studying the aetiological relationship between the two diseases.According to Katz (1941) chronic rheumatic heart disease may result in tracings showing preponderance of one or other ventricle resulting from valve deformities, or the appearance of large, broad, or notched P waves associated with auricular hypertrophy.Specific contour changes and arrhythmias may develop, such as frequent auricular prema- ture beats, which are said to be particularly significant when they arise from multiple foci.Electrocardiograms were taken from 29 patients.Left axis shift was present in 17; there was a considerable incidence of slurring of the QRS complexes, and the T wave was inverted in one case in Lead I, in another in Lead II, and in a third in Lead CF4.These abnormalities were consistent with the senile degeneration of the coronary arteries of old people, who formed the majority of the patients in this series.None of the records showed abnormal ventricular pre- ponderance, the P waves were well formed, and the cardiac rhythm was unaffected.A woman of 71, who gave a history of only three months' illness but who had obvious joint changes on x-ray examination, showed very low complexes in all leads when the first electrocardiogram was taken.Serial tracings showed an increasing amplitude of the complexes until five weeks later the voltage was well within normal limits.This suggests that there was transient myocardial damage during the acute phase of the illness, but it does not necessarily denote any common aetiological factor between rheumatoid arthritis and rheumatic fever; such findings might be encountered in many acute illnesses and toxic states.Only one patient in the present series came to necropsy.She was an elderly woman who died of cerebral thrombosis.The naked-eye appearances and histological findings in the heart revealed no evidence of rheumatic infection.