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PERSISTENT CONDUCTION DEFECTS FOLLOWING DIPHTHERIA

1939; BMJ; Volume: 1; Issue: 2 Linguagem: Inglês

10.1136/hrt.1.2.117

2053-5864

C. B. Perry,

Whether diphtheria commonly causes any permanent cardiac damage has long been the subject of discussion; but it is generally accepted that the per- sistence of electrocardiographic changes of any serious significance is extremely rare (Alstead, 1933 ; Beer, 1936 ; Begg, 1937 ; Hoskin, 1926 ; Jones and White, 1927; and Thompson, Golden, and White, 1937).It is not uncommon for complete heart block and bundle branch block to develop during the course of severe diphtheria, usually during the second week (Alstead, 1932 ; Begg, 1937 ; Franck, 1935 ; Place, 1932; and Schwensen, 1922).The mortality amongst cases showing these changes is high, but if the patient survives there is usually a complete cardiac recovery.Parkinson (1915) has described the case of a man, aged 22, who, on the twenty-second day of a severe attack of diphtheria, developed complete heart block.This lasted for eleven days, when auricular fibrillation supervened.At first the ventricular rate was slow (50 per minute), but later increased to 100-110 per minute.The fibrillation persisted for at least six months.Sprague and White (1927) have reported the case of a woman, aged 22, with complete heart block dating from diphtheria 19 years before.Read (1929) described a woman, aged 48, with complete heart block which, it was believed, dated from an attack of diphtheria at the age of 6; and Chamberlain and Alstead (1931) have published the details of a woman, aged 28, with complete heart block following diphtheria 18 years before.Butler and Levine (1930), investigating twenty cases with heart block of obscure origin, found a history of diphtheria in ten, whereas of 600 surgical cases studied as controls the incidence of a history of diphtheria was only six per cent.As a result of these observations it was suggested that diphtheria may predispose to the development of heart block in later life.However, Thompson, Golden, and White (1937) investigated ninety-one patients who had severe diphtheria 15 to 20 years previously, but found no evidence that diphtheria predisposed to the subsequent development of conduction defects.In view of the rarity of persistent defects in cardiac conduction after recovery from diphtheria, the three following cases appear worthy of record.In two there was persistent complete heart block and in one persistent bundle branch block.