Adams-Stokes attack as the first symptom of acute rheumatic fever: report of an adolescent case and review of the literature.

[acute rheumatic fever]

Acquired complete heart block , in pediatric age is mainly the results of direct injury to conduction tissue during cardiac surgery or cardiac catheterisation . It can also be observed in different clinical settings as infectious diseases , neoplasia , and inflammatory diseases . It has a wide range of presentation and in some settings it can appear a dramatic event . Although a rare finding during acute rheumatic fever , with a transient course , it may need a specific and intensive treatment .We report the case of an Adams-Stokes attack in an adolescent with acute rheumatic carditis and complete atrio-ventricular block . The attack was the first symptom of carditis .We reviewed the literature and could find 25 cases of complete atrio-ventricular block due to rheumatic fever . Ten of the 25 patients experienced an Adams-Stokes attack . Nineteen of the 25 patients were certainly in the pediatric age group . Seven of the 19 pediatric cases experienced an Adams-Stokes attack . In 16 /25 cases , the duration of the atrio-ventricular block was reported : it lasted from a few minutes to ten days . Pacemaker implantation was necessary in 7 cases .Rheumatic fever must be kept in mind in the diagnostic work-up of patients with acquired complete atrio-ventricular block , particularly when it occurs in pediatric patients . The insertion of a temporary pacemaker should be considered when complete atrio-ventricular block determines Adams-Stokes attacks . Complete heart block during acute rheumatic fever is rare and is usually transient . Along with endocarditis , myocarditis and pericarditis , complete atrio-ventricular block has been recognized , rarely , during the course of acute rheumatic carditis .

Diseases
Validation

Diseases presenting "endocarditis" symptom

acute rheumatic fever

cadasil

erdheim-chester disease

pyomyositis

This symptom has already been validated