Acute rheumatic fever presenting as complete heart block: report of an adolescent case and review of literature

Abstract

A 14-year-old boy suffering from chronic rheumatic heart disease came to the emergency department with recurrent episodes of presyncope and syncope. He was found to have complete heart block (CHB) and required temporary pacemaker insertion. Further workup revealed that CHB was secondary to acute rheumatic carditis. His atrioventricular (AV) conduction abnormalities recovered in a stepwise fashion over 5 days while he was being treated with corticosteroids, without the need for permanent pacemaker insertion. This case illustrates that acute rheumatic carditis can rarely present with advanced AV conduction block, which may be reversible.

Various Rhythmic Disturbance in Acute Rheumatic Fever: A Two-case Report

“…Myocardial involvement with conduction pathway abnormalities is considered a minimal myocardial dysfunction that may not be detected clinically [7]. Several studies reported rhythm conduction defects in ARF for decades, and 40-60% of patients exhibit a prolonged PR interval ( rst-degree atrioventricular (AV) block [8][9][10]. Other rhythm disturbances included accelerated junctional tachycardia, premature contractions, ventricular tachycardia, Torsade de pointes due to prolonged QT interval, complete bundle branch block and rarely second or third-degree AV block [5,[10][11][12].…”

“…Several studies reported rhythm conduction defects in ARF for decades, and 40-60% of patients exhibit a prolonged PR interval ( rst-degree atrioventricular (AV) block [8][9][10]. Other rhythm disturbances included accelerated junctional tachycardia, premature contractions, ventricular tachycardia, Torsade de pointes due to prolonged QT interval, complete bundle branch block and rarely second or third-degree AV block [5,[10][11][12]. The incidence of second-degree AV block (Mobitz I) was reported as 1.5%-2.6% and third-degree or complete AV block as 0.6%-4.6% in different studies [7][8].…”

“…Rhythmic disturbances in ARF have no correlation with valvular involvement [13][14][15][16][17]. Several studies reported that the occurrence of conduction defect is not a speci c sign of carditis [7,8,10,[12][13][14].…”

Akut Romatizmal Ateş Hastalığında Görülen Ritim ve İleti Bozuklukları

“…Blok bir hastada, hastalığın tekrarı esnasında ortaya çıkmıştır. Hastalardan 13'ünde senkop atakları oluşmuş, 12 hastaya geçici, bir hastaya ise kalıcı pacemaker takılmak zorunda kalınmıştır [16][17][18] . İkinci veya üçüncü derecede blok gelişen hastalarda, blok ile kapak tutulumu arasında bir ilişki gösterilememiştir.…”

Electrophysiology practice in low- and middle-income countries: An updated review on access to care and health delivery

“…Many endemic diseases of LMICs, such as malaria, dengue fever, and rheumatic heart disease (RHD), manifest as atrioventricular (AV) conduction defects or various atrial and ventricular arrhythmias. 4 , 5 In this review, the access to care, health delivery, diagnostic challenges, and treatment options are explored from the perspective of electrophysiology (EP) practice in LMICs.…”