Atrioventricular Block in Celiac Disease: An Unusual Clinical Presentation in a Child. A Case-Based Review

Mannarino, Savina; Santacesaria, Sara; Raso, Irene; Fini, Giulia; Pozzi, Elena; Cocuccio, Cristina; Calcaterra, Valeria; Zuccotti, Gian Vincenzo

doi:10.3390/children9111627

Cited by 5 publications

(5 citation statements)

References 22 publications

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Section: Discussionmentioning

confidence: 84%

“…Aside from CMP, several different cardiac manifestations have also been attributed to the presence of CD [12,[51][52][53]. Rhythm and conduction disturbances such as atrial fibrillation and AV block have all been described in the literature as possible complications of CD [52][53][54], some of which were seen in cases reported in this paper [28,41,55]. Moreover, vascular pathology, including accelerated atherosclerosis, thrombosis, and dysregulation of angiogenesis have all been linked to the presence of CD [13,[56][57][58].…”

Section: Discussionmentioning

confidence: 85%

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Cardiomyopathy in Celiac Disease: A Systematic Review

Milutinovic,

Jancic,

Adam

et al. 2024

JCM

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(1) Background: Cardiomyopathy in celiac disease or celiac cardiomyopathy (CCM) is a serious and potentially life-threatening disease that can occur in both adults and children. However, data supporting the causal relationship between celiac disease (CD) and cardiomyopathy (CMP) are still inconsistent. The aim of this study was to review and synthesize data from the literature on this topic and potentially reveal a more evidence-based causal relationship. (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to search Medline, Embase, and Scopus databases from database inception until September 2023. A total of 1187 original articles were identified. (3) Results: We identified 28 CCM patients (19 adult and 9 pediatric) with a mean age of 27.4 ± 18.01 years. Adult patients with CCM were predominantly male (84.2%) while pediatric patients were predominantly female (75%). The most common comorbidities associated with CCM were anemia (75%) and pulmonary hemosiderosis (20%). In 35% of patients, CCM occurred before the diagnosis of CD, while in 48% of patients, CCM and CD were diagnosed at the same time. Diagnosis of CD preceded diagnosis of CCM in only 18% of patients. Diagnosis of CCM is often delayed with an average, from the onset of symptoms to diagnosis, of 16 months. All patients were treated with a gluten-free diet in addition to guideline-directed medical therapy. At 11-month follow-up, cardiovascular improvement was seen in 60.7% of patients. Pediatric mortality was 33.3%, while adult mortality was 5.3%. (4) Conclusions: Clinicians should be aware of the possible association between CD and CMP, and we recommend CD work-up in all patients with CMP who have concomitant anemia. While we identified only 28 cases in the literature, many cases might go unreported due to a lack of awareness regarding CCM. A high degree of clinical suspicion and a prompt diagnosis of CCM are essential to minimizing the risks of morbidity and mortality, as the combination of a gluten-free diet and guideline-directed medical therapy can improve clinical outcomes.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 85%

Cardiomyopathy in Celiac Disease: A Systematic Review

Milutinovic,

Jancic,

Adam

et al. 2024

JCM

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“…A paediatric case of 4-year-old male with acquired progressive atrioventricular block who was diagnosed with celiac disease demonstrated a significant improvement of his conduction abnormality after a strict gluten-free diet. The authors of this case suggested screening for celiac disease in all children with acquired atrioventricular block [ 26 ] .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous recovery of isolated advanced heart block in patient with celiac disease by starting a strict gluten free diet: a case report and review of the literature

Maadarani,

Bigdelu,

Bitar

et al. 2023

European Journal of Case Reports in Internal Medicine

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Cardiac conduction disorder may have a wide range of aetiology and can manifest with symptomatic bradycardia and syncope. Celiac disease is a malabsorptive long-term autoimmune disorder where the small intestine is the primarily affected organ due to gluten intolerance in genetically predisposed individuals. The associations between celiac disease and cardiac pathology are uncommon. We report a case of a 50-year-old woman with a known case of celiac disease who presented with a symptomatic cardiac conduction abnormality that improved with a gluten-free diet.

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“…(7) Presentation patterns with atrioventricular block and syncope, suggesting that the myocardium is affected in CDs, have also been demonstrated in isolated cases. (9,10) In the literature, QTc interval prolongation was observed in one-third of untreated adult CDs, whereas this rate was 3% in patients on a gluten free diet. (11) In the literature there are a lot of studies investigating the relationship of the diet and the ventricular repolarization parameters.…”

Section: Discussionmentioning

confidence: 99%

Çölyak Hastalarında Elektrokardiyografik Değerlendirmenin Önemi

Taşkın

Orgun

2023

Osmangazi̇ Journal of Medicine

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At the present study, study we aimed to analyze the risk factors for cardiac arrhythmias related disease factors by evaluating some ventricular repolarization parameters in the electrocardiographic (ECG) evaluation of CD. The study was conducted retrospectively from the files of the patients. The ECG evaluation of 63 patients aged 5-18 years diagnosis with CD and 63 healthy control group in Adana City Training and Research Hospital, between 01.2018-11.2022. Patients who were taking any drugs, who had a chronic disease and/or abnormal tests (vitamin B12, folate, tissue transglutaminase, anti-endomysium antibody titers) were excluded from the study. The ventricular repolarization parameters (QT interval, QTc interval, QT dispersion, QTc dispersion, Tp-e interval, Tp-e/QT, Tp-e/QTc) analyzed on ECG and compared both groups. The measured ventricular repolarization parameters of the patients and control groups were not statistically different. From the ECG data, it was found that the QTc min value was higher in patients diagnosed before 5 years old than the patients diagnosed after 8 years old. While the QTc dispersion was higher in patients diagnosed after 8 years old than the patients with an age at diagnosed before 5 years old. It was found that the values of QT min, QT max, and QT in the ECG were influenced by the duration of the disease and significantly high related with the disease duration (more than 5 years). We found that QTc dispersion was higher in patients with a later diagnosis. This suggests that cardiac involvement is also increased in patients with a late diagnosis.

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Atrioventricular Block in Celiac Disease: An Unusual Clinical Presentation in a Child. A Case-Based Review

Cited by 5 publications

References 22 publications

Cardiomyopathy in Celiac Disease: A Systematic Review

Cardiomyopathy in Celiac Disease: A Systematic Review

Spontaneous recovery of isolated advanced heart block in patient with celiac disease by starting a strict gluten free diet: a case report and review of the literature

Çölyak Hastalarında Elektrokardiyografik Değerlendirmenin Önemi

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