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Acute rheumatic fever with advanced degree AV block
D V Reddy1, L T Chun, L G Yamamoto
1Department of Pediatrics, University of Hawaii, John A. Burns School of Medicine, Kapiolani Medical Center For Women and Children, Honolulu.
Abstract:
Five cases are described of acute rheumatic fever meeting the modified Jones criteria with evidence of second or third degree atrioventricular block (AVB). One patient required a temporary transvenous pacemaker and two patients were treated with corticosteroids. One patient had an associated valvulitis. There was no long-term sequelae due to the AVB in any of the patients. The duration of the advanced degree AVB had a range of about 2 to 12 days. The cause of this advanced degree AVB is uncertain. Advanced degree AVB with acute rheumatic fever appears to be self-limited in most instances. Unlike rheumatic valvulitis, it is not associated with significant permanent morbidity.
Insights
Acute rheumatic fever can cause severe heart block (AVB), but it typically resolves without lasting damage. This study highlights that advanced atrioventricular block in rheumatic fever is usually temporary.
Area of Science:
- Cardiology
- Rheumatology
- Pediatric Cardiology
Background:
- Acute rheumatic fever (ARF) is an inflammatory condition following streptococcal infection.
- Atrioventricular block (AVB) is a potential cardiac manifestation of ARF.
- The natural history and long-term impact of advanced AVB in ARF require further elucidation.
Observation:
- Five cases of ARF meeting modified Jones criteria presented with second or third-degree AVB.
- One patient required a temporary transvenous pacemaker, and two received corticosteroid treatment.
- Associated valvulitis was noted in one patient; however, no long-term sequelae from AVB were observed.
Findings:
- The duration of advanced AVB ranged from approximately 2 to 12 days.
- The exact etiology of AVB in these ARF cases remains uncertain.
- Advanced degree AVB associated with ARF appears to be a self-limited condition in most patients.
Implications:
- Unlike rheumatic valvulitis, advanced AVB in ARF does not typically lead to significant permanent morbidity.
- This suggests a favorable prognosis for AVB in the context of acute rheumatic fever.
- Further research into the mechanisms and management of AVB in ARF is warranted.