Auriculoventricular nodal rhythm with heart block.
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We describe 2 patients with systemic lupus erythematosus (SLE) and high grade atrioventricular (AV) block. In one patient anti-Ro antibodies were positive. This antibody has been associated with congenital complete heart block in children of mothers with SLE; however, its role in adult high grade AV block is not clear. We reviewed the 8 published cases of adults with SLE and high grade AV block. The possible mechanisms that could be implicated in the pathology of high grade AV block are discussed.
A 2:1 atrioventricular block developed during treatment with the tricyclic antidepressant imipramine in a 74-year-old man with a three-year history of right bundle-branch block. Serial cardiographic studies and determinations of blood imipramine concentrations showed that the heart block was directly related to the plasma concentration of the drug and occurred below the atrioventricular node in the His-Purkinje system.
A 41-year-old man died of meningococcemia after presenting with skin rash, fever, and bradycardia. Electrocardiograms demonstrated intermittent complete heart block, and necropsy showed myocarditis with focal necrosis of the conduction system. This syndrome should be recognized as typical for meningococcemia, and all patients with meningococcal disease should be observed carefully for the development of bradycardia.
OBJECTIVE: To assess the longterm cardiologic and immunologic outcome of children with isolated congenital complete heart block (CCHB) and their HLA antigens. METHODS: Sixteen children with isolated CCHB were investigated. HLA typing was done using a microcytotoxicity test. RESULTS: Three patients died (18.7%), one in utero (35 weeks), one 2 days after birth, and one at 6 years of age. The mean age of the 13 living children is now 18.3 years (range 2-34). Eight (50%) have been permanently paced for symptoms. No patient developed clinical symptoms or serological abnormalities suggesting immune disease. The A31 antigen was more prevalent, but one pair of HLA identical twins was observed, and only one had CCHB. CONCLUSION: Patients with isolated CCHB have significant cardiac mortality, and after a long followup many of them are paced to control symptoms, but in our small sample those who survive the perinatal period mostly lead a normal life. The longterm immunological outcome of these children seems good. CCHB is not related to a specific HLA pattern in affected children.
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We describe a patient with relapsing polychondritis who developed fatal cardiac involvement comprising complete heart block, acute aortic incompetence, and cardiovascular collapse. Pathologic studies showed fibrosis of the cardiac conducting system and necrotizing inflammation of the aortic valve, features not previously described in relapsing polychondritis, as well as evidence of coronary artery vasculitis.
We report the obstetric history of a woman, who between 15 spontaneous abortions, gave birth to a child with congenital heart block. She later developed systemic lupus erythematosus, had antibodies to SS-A/Ro and SS-B/La but was repeatedly negative for antiphospholipid antibodies.
We report a case of complete heart block (CHB) and polymorphic ventricular tachycardia (VT) which was associated with a modest-sized myocardial infarction (MI) following incidental occlusion of the first septal perforator (FSP) branch after stent deployment to the left anterior descending (LAD) coronary artery. These complications were successfully treated with temporary pacing and subsequently resolved with spontaneous recanalization of the first septal perforator. This case represents an interesting product of medical progress which defies the adverse natural history and poor prognosis of anteroseptal MI associated with CHB due to the small amount of myonecrosis associated with this event.