title: Adams-Stokes attack as the first symptom of acute rheumatic fever: report of an adolescent case and review of the literature.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Paediatrics-Paediatric Cardiology Unit, University of Parma, via Gramsci, 14 43126, Parma, Italy. nicola.carano@unipr.it
authors.forename: Nicola
authors.initials: N
authors.lastname: Carano
authors.forename: Ilaria
authors.initials: I
authors.lastname: Bo
authors.forename: Bertrand
authors.initials: B
authors.lastname: Tchana
authors.forename: Erica
authors.initials: E
authors.lastname: Vecchione
authors.forename: Silvia
authors.initials: S
authors.lastname: Fantoni
authors.forename: Aldo
authors.initials: A
authors.lastname: Agnetti
mesh_terms: D000208:Acute Disease; D000219:Adams-Stokes Syndrome / Q000175:diagnosis* / Q000628:therapy; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012213:Rheumatic Fever / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000893:Anti-Inflammatory Agents