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Atrioventricular Conduction in Children With Acute Rheumatic Fever FREE

Shyamal K. Sanyal, FAAP, FACC; Mohinder K. Thapar, MD, DCH; Dharm Bhushan Sharma, MD; Om Prabash Shrivastava, BSc
[+] Author Affiliations

Received for publication Jan 20, 1975; accepted June 11.

Read in part before the annual meeting of the American Academy of Pediatrics, Washington, DC, 1975.

Reprint requests to Pediatric Cardiology, St Jude Children's Research Hospital, PO Box 318, Memphis, TN 38101 (Dr Sanyal).


Am J Dis Child. 1976;130(5):473-476. doi:10.1001/archpedi.1976.02120060019004.
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• Atrioventricular conduction was quantitatively evaluated in 118 children with acute rheumatic fever. The mean PR index in children with acute rheumatic fever, 1.06 ± 0.38, was significantly higher than normal children or children who had febrile illness of nonrheumatic or nonstreptococcal origin (P <.001). Among 35 children with rheumatic fever and an abnormal PR index, the disease presented as carditis in 21, arthritis in ten, and chorea in four. The mean PR index and the frequency distribution of abnormal PR indices were significantly higher in children with carditis (P <.001). Five children who initially had an abnormal PR index and arthritis or chorea subsequently developed carditis. These observations suggest that children with acute rheumatic fever and abnormal PR index warrant close observation for possible clinical evidence of myocardial involvement during subsequent course of the illness.

(Am J Dis Child 130:473-476, 1976)

REFERENCES

Clarke M, Keith JD:  Atrioventricular conduction in acute rheumatic fever . Br Heart J 34:472-479, 1972;.
Link to Article
Taran LM:  Laboratory and clinical criteria of rheumatic carditis in children . J Pediatr 29:77-89, 1946;.
Link to Article
Jones criteria (modified) for guidance in the diagnosis of rheumatic fever . New York, American Heart Association, 1955;.
Guntheroth WG: Pediatric Electrocardiography: Normal and Abnormal Patterns, Incorporating Vector Approach . Philadelphia, WB Saunders Co, 1966;, pp 23-24.
Nadas AS, Fyler DC: Pediatric Cardiology , ed 3. Philadelphia, WB Saunders Co, 1972;, p 47.
Mirowski M:  Diagnostico cualitativo y cuantitativo del bloqueo A-V de primer grado: Un neuvo indice para valorar la conduction auriculoventricular . Arch Inst Cardiol Mex 31:67-71, 1961;.
Mirowski M, Arevalo F, Medrano GA, et al:  Conduction disturbances in patent ductus asteriosus: A study of 200 cases before and after surgery with determinations of P-R index . Circulation 25:807-813, 1962;.
Link to Article
Mirowski M, Rosenstein BJ, Markowitz M:  A comparison of atrio-ventricular conduction in normal children and in patients with rheumatic fever, glomerulonephritis and acute febrile illnesses: A quantitative study with determination of the P-R index . Pediatrics 33:334-340, 1964;.
Sanyal SK, Thapar, MK, Ahmed SH, et al:  The initial attack of acute rheumatic fever during childhood in North India: A prospective study of the clinical profile . Circulation 49:7-12, 1974;.
Link to Article
Parkinson J, Gross AH, Gunson EB:  The heart and its rhythm in acute rheumatism . Q J Med 13:363-379, 1920;.
Link to Article
Cohn AE, Swift HF:  Electrocardiographic evidence of myocardial involvement in rheumatic fever . J Exp Med 39:1-35, 1924;.
Link to Article
Sokolow M:  Significance of electrocardiographic changes in rheumatic fever . Am J Med 5:365-378, 1948;.
Link to Article
Blackman NS, Hamilton CI Jr:  Serial electrocardiographic changes in young adults with acute rheumatic fever: Report of 62 cases . Ann Intern Med 29:416-431, 1948;.
Link to Article
Gross L, Fried BM:  Lesions in the auriculo ventricular conduction system occurring in rheu matic fever . Am J Pathol 12:31-44, 1936;.
Bruenn HG:  The mechanism of impaired auriculo-ventricular conduction in acute rheumatic fever . Am Heart J 13:413-425, 1937;.
Link to Article
Keith JD:  Over-stimulation of the vagus nerve in rheumatic fever . Q J Med 7:29-41, 1938;.
Rammelkamp CH Jr, Stolzer BL:  The treatment and prevention of rheumatic fever . Pediatr Clin North Am 1:265-274, 1954;.
Rantz LA, Boisvert PJ, Spink WW:  The etiology and pathogenesis of rheumatic fever . Arch Intern Med 76:131-138, 1945;.
Link to Article
Kaplan MH, Meyeserian M:  Immunologic cross-reaction between group-A streptococcal cells and human heart tissue . Lancet 1:706-710, 1962;.
Link to Article
Kaplan MH, Bolande R, Rakita L, et al:  Presence of bound immunoglobulins and complement in the myocardium in acute rheumatic fever . N Engl J Med 271:637-645, 1964;.
Link to Article
Goldstein I, Halpran B, Robert L:  Immunological relationship between streptococcus: A polysaccharide and the structural glycoproteins of the heart valves . Nature 213:44-47, 1967;.
Link to Article

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References

Clarke M, Keith JD:  Atrioventricular conduction in acute rheumatic fever . Br Heart J 34:472-479, 1972;.
Link to Article
Taran LM:  Laboratory and clinical criteria of rheumatic carditis in children . J Pediatr 29:77-89, 1946;.
Link to Article
Jones criteria (modified) for guidance in the diagnosis of rheumatic fever . New York, American Heart Association, 1955;.
Guntheroth WG: Pediatric Electrocardiography: Normal and Abnormal Patterns, Incorporating Vector Approach . Philadelphia, WB Saunders Co, 1966;, pp 23-24.
Nadas AS, Fyler DC: Pediatric Cardiology , ed 3. Philadelphia, WB Saunders Co, 1972;, p 47.
Mirowski M:  Diagnostico cualitativo y cuantitativo del bloqueo A-V de primer grado: Un neuvo indice para valorar la conduction auriculoventricular . Arch Inst Cardiol Mex 31:67-71, 1961;.
Mirowski M, Arevalo F, Medrano GA, et al:  Conduction disturbances in patent ductus asteriosus: A study of 200 cases before and after surgery with determinations of P-R index . Circulation 25:807-813, 1962;.
Link to Article
Mirowski M, Rosenstein BJ, Markowitz M:  A comparison of atrio-ventricular conduction in normal children and in patients with rheumatic fever, glomerulonephritis and acute febrile illnesses: A quantitative study with determination of the P-R index . Pediatrics 33:334-340, 1964;.
Sanyal SK, Thapar, MK, Ahmed SH, et al:  The initial attack of acute rheumatic fever during childhood in North India: A prospective study of the clinical profile . Circulation 49:7-12, 1974;.
Link to Article
Parkinson J, Gross AH, Gunson EB:  The heart and its rhythm in acute rheumatism . Q J Med 13:363-379, 1920;.
Link to Article
Cohn AE, Swift HF:  Electrocardiographic evidence of myocardial involvement in rheumatic fever . J Exp Med 39:1-35, 1924;.
Link to Article
Sokolow M:  Significance of electrocardiographic changes in rheumatic fever . Am J Med 5:365-378, 1948;.
Link to Article
Blackman NS, Hamilton CI Jr:  Serial electrocardiographic changes in young adults with acute rheumatic fever: Report of 62 cases . Ann Intern Med 29:416-431, 1948;.
Link to Article
Gross L, Fried BM:  Lesions in the auriculo ventricular conduction system occurring in rheu matic fever . Am J Pathol 12:31-44, 1936;.
Bruenn HG:  The mechanism of impaired auriculo-ventricular conduction in acute rheumatic fever . Am Heart J 13:413-425, 1937;.
Link to Article
Keith JD:  Over-stimulation of the vagus nerve in rheumatic fever . Q J Med 7:29-41, 1938;.
Rammelkamp CH Jr, Stolzer BL:  The treatment and prevention of rheumatic fever . Pediatr Clin North Am 1:265-274, 1954;.
Rantz LA, Boisvert PJ, Spink WW:  The etiology and pathogenesis of rheumatic fever . Arch Intern Med 76:131-138, 1945;.
Link to Article
Kaplan MH, Meyeserian M:  Immunologic cross-reaction between group-A streptococcal cells and human heart tissue . Lancet 1:706-710, 1962;.
Link to Article
Kaplan MH, Bolande R, Rakita L, et al:  Presence of bound immunoglobulins and complement in the myocardium in acute rheumatic fever . N Engl J Med 271:637-645, 1964;.
Link to Article
Goldstein I, Halpran B, Robert L:  Immunological relationship between streptococcus: A polysaccharide and the structural glycoproteins of the heart valves . Nature 213:44-47, 1967;.
Link to Article

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