Rheumatic heart disease in the young in Iraq.

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Abstract
Rheumatic heart disease is still the leading heart disease in Iraq with a high incidence in young patients; of 357 patients studied 39 percent were under 20 yr. of age. There were 213 female (60 percent) and 144 male (40 percent) patients studied with a female-to-male ratio of 1- 5:1. The majority of patients were severely incapacitated by the disease when 1st seeking medical advice. Mitral stenosis was found in 210 patients with a female-to-male ratio of 2:1. In children the sex incidence was in favor of boys with a ratio of 4: 3. Mitral incompetence was found in 35 young patients (under 20 years), (25.2 percent), and 23 older (over 20 years) patients (10. 6 percent) with the same sex incidence as in mitral stenosis. Mitral incompetence was the main valvar lesion in all patients under the age of 11 yr. Aortic stenosis was absent in young patients and present in 7 older patients with equal sex incidence. Aortic incompetence was present in 5 young patients (3. 6 percent) and 9 older patients (4.1 percent) with a male-to-female ratio of 5:1 in younger and 8.1 in older patients. There was a close similarity between the present figures and those from other developing countries in Asia and Africa, but there were considerable differences between those in the Western hemisphere, where mitral valve disease in children is less common. Poor hygienic conditions, overcrowding, bad housing, inadequate medical treatment and prophylaxis, and possibly a nutritional factor may all contribute to the high incidence of rheumatic heart disease of Iraq.