Yakut Kahraman, Eybek Busra, Erolu Elif, Karacan Mehmet
Department of Pediatric Cardiology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkiye.
Department of Pediatrics, Umraniye Training and Research Hospital, Istanbul, Turkiye.
North Clin Istanb. 2020 Dec 16;9(3):279-281. doi: 10.14744/nci.2020.69370. eCollection 2022.
Acute rheumatic fever (ARF) is a systemic autoimmune disease that results from abnormal immune response to group A streptococcus pharyngitis. Although first-degree atrioventricular (AV) block is the most common rhythm problem associated with the disease, other conduction abnormalities also could be seen. We reported three different types of conduction defects (first-degree AV block, second-degree AV block, and complete AV block) in a 15-year-old case diagnosed with ARF. A 15-year-old male patient presented with palpitation. Physical examination findings were unremarkable except dysrhythmic heart sounds. Acute phase reactants were positive, and electrocardiogram showed second-degree type I AV block at hospital admission. In the 2 day of admission, right first metatarsophalangeal arthritis as well as arthralgia involved both knees and ankles developed. Echocardiography revealed moderate rheumatic mitral regurgitation. First-degree AV block with brief complete AV block episode was seen on 24 h rhythm Holter recordings. Based on clinical and laboratory findings, ARF diagnosis was made and anti-inflammatory therapy (naproxen sodium) with benzathine penicillin G was started to the patient. First-degree AV block lasted 3 weeks and other conduction disorders were not seen again first, second, and complete AV block which could be seen during ARF episode and ARF should be considered as a one of the causes of arrhythmias.
急性风湿热（ARF）是一种全身性自身免疫性疾病，由对A组链球菌性咽炎的异常免疫反应引起。虽然一度房室（AV）传导阻滞是与该疾病相关的最常见节律问题，但也可见其他传导异常。我们报告了一例15岁诊断为ARF的病例中出现的三种不同类型的传导缺陷（一度AV传导阻滞、二度AV传导阻滞和完全性AV传导阻滞）。一名15岁男性患者因心悸就诊。体格检查结果除心律不齐的心音外无异常。急性期反应物呈阳性，入院时心电图显示一度I型AV传导阻滞。入院第2天，右第一跖趾关节关节炎以及累及双膝和双踝的关节痛出现。超声心动图显示中度风湿性二尖瓣反流。24小时动态心电图记录显示一度AV传导阻滞伴短暂完全性AV传导阻滞发作。根据临床和实验室检查结果，作出ARF诊断，并开始对患者使用苄星青霉素G进行抗炎治疗（萘普生钠）。一度AV传导阻滞持续了3周，未再出现其他传导障碍，一度、二度和完全性AV传导阻滞可见于ARF发作期间，ARF应被视为心律失常的原因之一。
