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Sinus Node Dysfunction Presenting as Syncope in Acute Rheumatic Fever - A Case Report

CASE REPORT, January 2015, VOL III ISSUE I, ISSN 2042-4884
10.5083/ejcm.20424884.129 , Cite or Link Using DOI
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Navdeep Singh Sidhu MD, P Srinivas MD DM, Prakash Sadashivappa Surhonne MD DM, Shivakumar Bhairappa MD DM, Shankar Somanna MD DM and Cholenahally Nanjappa Manjunath MD DM

Abstract

Rheumatic fever may be associated with a variety of cardiac conduction and rhythm disturbances. First-degree heart block is a common occurrence in acute rheumatic fever and is included in Jones’ criteria. Other electrocardiographic changes such as sinus tachycardia, bundle branch blocks, nonspecific ST-T wave changes, atrial and ventricular premature complexes have been reported with variable frequency. Rarely, complete heart block may be a manifestation of acute rheumatic fever. Sinus node dysfunction has been reported as an exceptionally rare manifestation of acute rheumatic fever. We report a case of 33 year old female who developed syncope due to sinus node dysfunction during an episode of acute rheumatic carditis.


Introduction

Rheumatic fever is a multisystem disease occurring as a sequelae to group A beta hemolytic streptococci and is still a major health problem in the developing world. Diagnosis of rheumatic fever is based on revised Jones criteria.1 Carditis, migratory polyarthritis, Syndehams chorea, erythema marginatum and subcutaneous nodules are the major criteria while fever, arthralgia, increased acute phase reactants and prolonged PR interval are the minor criteria. Complete atrioventricular block presenting as syncope has been described as a rare manifestation of rheumatic fever. We present the case of a middle aged woman with rheumatic carditis presenting as sinus node dysfunction and syncope.