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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: Ross.Nicholson@middlemore.co.nz
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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
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Copyright
© Cambridge University Press 2019 

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