Oba Yusuke, Watanabe Hiroaki, Nishimura Yoshioki, Ueno Shuichi, Nagashima Takao, Imai Yasushi, Shimpo Masahisa, Kario Kazuomi
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University.
Int Heart J. 2015;56(6):664-7. doi: 10.1536/ihj.15-091. Epub 2015 Nov 9.
A 45-year-old hypertensive Japanese woman presented with epigastric pain on inspiration, fever, complete atrioventricular block and polyarthritis. Her antistreptolysin O levels were markedly elevated. A diagnosis of rheumatic fever was made according to the modified Jones criteria. She was prescribed loxoprofen sodium, which was partially effective for her extracardiac clinical symptoms. However, she had syncope due to complete atrioventricular block with asystole longer than 10 seconds. Consequently, we implanted a permanent pacemaker. Although we prescribed prednisolone, the efficacy of which was limited for the patient's conduction disturbance, the complete atrioventricular block persisted. In our systematic review of 12 similar cases, the duration of complete heart block was always transient and there was no case requiring a permanent pacemaker. We thus encountered a very rare case of adult-onset acute rheumatic fever with persistent complete atrioventricular block necessitating permanent pacemaker implantation.
一名45岁的日本高血压女性患者，出现吸气时上腹部疼痛、发热、完全性房室传导阻滞和多关节炎。她的抗链球菌溶血素O水平显著升高。根据改良的琼斯标准诊断为风湿热。给她开了洛索洛芬钠，对她的心脏外临床症状有部分疗效。然而，她因完全性房室传导阻滞伴心搏停止超过10秒而发生晕厥。因此，我们为她植入了永久性起搏器。尽管我们开了泼尼松龙，但对患者的传导障碍疗效有限，完全性房室传导阻滞仍然存在。在我们对12例类似病例的系统评价中，完全性心脏传导阻滞的持续时间总是短暂的，没有一例需要永久性起搏器。因此，我们遇到了一例非常罕见的成人急性风湿热病例，伴有持续性完全性房室传导阻滞，需要植入永久性起搏器。
