Korean Circ J.  2009 Mar;39(3):121-123. 10.4070/kcj.2009.39.3.121.

Complete Atrioventricular Block in an Adolescent With Rheumatic Fever

• Yoo GH

• KMID: 1825970
• DOI: http://doi.org/10.4070/kcj.2009.39.3.121

Abstract

Rheumatic fever is an acute inflammatory sequela following a group A, beta-hemolytic streptococcal infection. Rheumatic fever is characterized by polyarthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum as the major diagnostic criteria. Rarely, advanced heart block may also occur. A 13-year-old boy was admitted to the Pediatric Department for evaluation and management of complete atrioventricular block. The patient had exertional dyspnea for 1 month. Based on the findings of mitral regurgitation, fever, elevated acute phase reactants, and a high antistreptolysin O titer, the patient was diagnosed with rheumatic fever. A benzathine penicillin injection was administered, as well as salicylate therapy. On the 5th day of hospitalization, the electrocardiogram revealed a normal sinus rhythm with a 1st degree atrioventricular block. After discharge, the electrocardiogram normalized with the monthly penicillin injections. Herein we report a case of complete atrioventricular block associated with rheumatic fever. The heart block resolved without specific cardiac treatment, other than a non-steroidal anti-inflammatory medication.

Keyword

Atrioventricular block; Rheumatic fever

MeSH Terms

Acute-Phase Proteins
Adolescent
Antistreptolysin
Arthritis
Atrioventricular Block
Chorea
Dyspnea
Electrocardiography
Erythema
Ethylenediamines
Fever
Heart Block
Hospitalization
Humans
Mitral Valve Insufficiency
Myocarditis
Penicillin G Benzathine
Penicillins
Rheumatic Fever
Streptococcal Infections
Acute-Phase Proteins
Antistreptolysin
Ethylenediamines
Penicillin G Benzathine
Penicillins

Figure

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  Fig. 1 Electrocardiogram depicts complete heart block with a ventricular rate of 77 on the day of admission.

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  Fig. 2 Electrocardiogram on the 3rd day of hospitalization depicts 2nd degree atrioventricular block (Mobitz II) combined with PR prolongation.

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  Fig. 3 Electrocardiogram shows 1st degree atrioventricular block on the 5th day of hospitalization.

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  Fig. 4 Electrocardiogram shows a normalized PR interval at the outpatient department visit.

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