Cardiac blocks in acute rheumatic fever: from complete AV block to sinus rhythm

Acute rheumatic fever is a systemic autoimmune disease resulting from an abnormal immune response to group A streptococcal pharyngitis. Cardiac findings are an important part of acute rheumatic fever and usually manifest as electrocardiographic abnormalities. The most common arrhythmia is first-degree atrioventricular block; however, in rare cases, complete atrioventricular block may occur. In this article, we present the case of an 11-year-old child who presented with complaints of knee pain and limited movement, in whom the diagnosis of acute rheumatic fever was suspected based on clinical, echocardiographic, and laboratory findings, and in whom complete atrioventricular block was detected on electrocardiographic. The patient's electrocardiographic initially showed complete atrioventricular block, but with the treatment process, different levels of complete atrioventricular block were observed, and the electrocardiographic findings returned to normal. Particularly in patients who develop complete atrioventricular block, the response to treatment should be evaluated before making rapid decisions for pacemaker implantation, taking into account that the arrhythmia may be transient and can be corrected with medical treatment. This article emphasises that electrocardiographic abnormalities should not be ignored when diagnosing acute rheumatic fever and that patients should be evaluated in a holistic manner.