Advanced atrioventricular block in a 39-year-old man with acute rheumatic fever

This report describes the development of advanced (2:1 and 3:1) AV block in a 39-year-old man with acute rheumatic fever. AV block progressed from first-degree to type I second-degree and finally to advanced AV block. The latter lasted 5 days. AV block regressed in a stepwise fashion via sustained type I second-degree AV block and eventually first-degree AV block. The PR interval returned to normal several weeks after resolution of second-degree AV block. In view of the resurgence of acute rheumatic fever, the diagnosis of acute rheumatic fever should now be considered in young adults or middle-aged patients presenting with second-degree or third-degree AV block of undetermined etiology.