Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-26T03:09:00.310Z Has data issue: false hasContentIssue false
  • English
  • Français

Beyond first-degree heart block in the diagnosis of acute rheumatic fever

Published online by Cambridge University Press:  14 June 2019

Joshua Agnew ,
Nigel Wilson ,
Jonathan Skinner  and
Ross Nicholson Open the ORCID record for Ross Nicholson [Opens in a new window]
Joshua Agnew
Affiliation:
Bay of Plenty District Health Board, Tauranga, New Zealand
Nigel Wilson
Affiliation:
Green Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland, New Zealand
Jonathan Skinner
Affiliation:
Green Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland, New Zealand
Ross Nicholson*
Affiliation:
KidzFirst Children’s Hospital, South Auckland, New Zealand
*
Author for correspondence: Dr Ross Nicholson, Consultant Paediatrician, KidzFirst Children’s Hospital, Counties Manukau Health, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand. Tel: +64 9 276 0044 ext 57003.; Fax: +6492760192; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

First-degree heart block is a minor manifestation of acute rheumatic fever. Second and third degree heart block and junctional rhythms occur less commonly. We report patients presenting with these latter three electrocardiographic abnormalities and investigate their diagnostic utility.

Design:

Patients admitted to our centre meeting the 2014 New Zealand Rheumatic Fever Guideline Diagnostic Criteria for rheumatic fever over a 5-year period from January 2010 to December 2014 were identified. Clinical, haematologic, electrocardiographic, and echocardiographic records were reviewed. Electrocardiograms (ECG) were considered abnormal if there was second- or third-degree atrioventricular block or junctional rhythms. Comparative data from patients with advanced conduction abnormalities without a diagnosis of rheumatic fever during the same time period were reviewed.

Results:

A total of 201 patients met inclusion criteria for rheumatic fever. Of these, 17 (8.5%) had transient abnormalities of atrioventricular conduction, 5 (2.5%) with second or third-degree atrioventricular block, and 12 (6%) junctional rhythms. The remaining 173 (86%) patients had evidence of rheumatic valvulitis at presentation. Only one patient without rheumatic fever was found to have advanced conduction abnormalities over the study period, from a total of 3702 ECG.

Conclusions:

This large contemporary cohort of acute rheumatic fever shows that 8.5% of cases had either advanced atrioventricular block or junctional rhythms both highly suggestive of the diagnosis in our population.

Keywords

Rheumatic feverjunctional rhythmheart block
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 6 , June 2019 , pp. 744 - 748
Check for updates
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

New Zealand Heart Foundation. New Zealand Guidelines for Rheumatic Fever: Diagnosis, Management and Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease: 2014 Update. Auckland, 2014.Google Scholar
Jaine, R, Baker, M, Venugopal, K. Epidemiology of acute rheumatic fever in New Zealand 1996–2005. J Paediatr Child Health 2008; 44: 564–571.CrossRefGoogle ScholarPubMed
Wilson, N. Rheumatic heart disease in indigenous populations – New Zealand experience. Heart Lung Circ 2010; 19: 282–288.10.1016/j.hlc.2010.02.021CrossRefGoogle ScholarPubMed
Neutze, JM. Rheumatic fever and rheumatic heart disease in the western Pacific region. N Z Med J 1988; 101: 404–406.Google ScholarPubMed
Karacan, M, Isikay, S, Olgun, H, et al. Asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever: 24-hour electrocardiography study. Cardiol Young 2010; 20: 620–630.CrossRefGoogle ScholarPubMed
Ceviz, N, Celik, V, Olgun, H, et al. Accelerated junctional rhythm in children with acute rheumatic fever: is it specific to the disease? Cardiol Young 2014; 24: 464–468.10.1017/S1047951113000620CrossRefGoogle ScholarPubMed
Balli, S, Oflaz, MB, Kibar, AE, et al. Rhythm and conduction analysis of patients with acute rheumatic fever. Pediatr Cardiol 2013; 34: 383–389.CrossRefGoogle ScholarPubMed
Clarke, M, Keith, JD. Atrioventricular conduction in acute rheumatic fever. Br Heart J 1972; 34: 472–479.10.1136/hrt.34.5.472CrossRefGoogle ScholarPubMed
Cristal, N, Stern, J, Gueron, M. Atrioventricular dissociation in acute rheumatic fever. Br Heart J 1971; 33: 12–15.10.1136/hrt.33.1.12CrossRefGoogle ScholarPubMed
Zalzstein, E, Maor, R, Zucker, N, et al. Advanced atrioventricular conduction block in acute rheumatic fever. Cardiol Young 2003; 13: 506–508.10.1017/S1047951103001082CrossRefGoogle ScholarPubMed
Freed, MS, Sacks, P, Ellman, MH. Ventricular tachycardia in acute rheumatic fever. Arch Intern Med 1985; 145: 1904–1905.10.1001/archinte.1985.00360100174029CrossRefGoogle ScholarPubMed
Tan, KS, Lau, YS, Teo, WS. T wave alternans and acute rheumatic myocarditis: a case report. Ann Acad Med Singapore 1999; 28: 455–458.Google Scholar
Liberman, L, Hordof, AJ, Alfayyadh, M, et al. Torsade de pointes in a child with acute rheumatic fever. J Pediatr 2001; 138: 280–282.CrossRefGoogle Scholar
Yahalom, M, Jerushalmi, J, Roguin, N. Adult acute rheumatic fever: a rare case presenting with left bundle branch block. Pacing Clin Electrophysiol 1990; 13: 123–127.CrossRefGoogle ScholarPubMed
Park, MK. Park’s Pediatric Cardiology for Practitioners. In: Park, MK (ed), 6th edn. Elsevier Saunders, Philadelphia, PA, 2014.Google Scholar
Parkinson, J, Gosse, AH, Gunson, EB. The heart and its rhythm in acute rheumatism. Q J Med 1920; 13: 363–379.CrossRefGoogle Scholar
Tani, LY. Rheumatic fever and rheumatic heart disease. In: Allen, HD, Driscoll, DJ, Shaddy, RE, Feltes, TF (eds). Moss and Adams Heart Disease in Infants, Children, and Adolescents, Including the Fetus and Young Adult, 7th edn. Lippincott Williams & Wilkins, Philadelphia, PA, 2008: 1256–1280.Google Scholar
Ziegler, RF. Electrocardiographic Studies in Normal Infants and Children. Charles C Thomas Publishers, Springfield, IL, 1951: 3–9.Google Scholar
Carano, N, Bo, I, Tchana, B, et al. Adams-Stokes attack as the first symptom of acute rheumatic fever: report of an adolescent case and review of the literature. Ital J Pediatr 2012; 38: 61.CrossRefGoogle ScholarPubMed
Phornphutkul, C, Damrongsak, D, Silpisornkosol, S. Steroid therapy in cardiac conduction disturbances in children with diptheria. Mod Med Asia 1978; 14: 38, 43–44.Google ScholarPubMed
Seferovic, PM, Ristic, AD, Maksimovic, R, et al. Cardiac arrhythmias and conduction disturbances in autoimmune rheumatic diseases. Rheumatology (Oxford) 2006; 45: iv39–iv42.CrossRefGoogle ScholarPubMed
Sigal, LH. Early disseminated Lyme disease: cardiac manifestations. Am J Med 1995; 98: 25S–28S; discussion 28S–29S.CrossRefGoogle ScholarPubMed