Buradasınız

Anasayfa » Content

ERİŞKİN SİSTEMİK LUPUS ERİTEMATOZUS VE 2. DERECE ATRİYOVENTRİKÜLER BLOK

ADULT SYSTEMIC LUPUS ERYTHEMATOSUS AND SECOND-DEGREE ATRIOVENRICULAR BLOCK

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2009

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Systemic lupus erythematosus (SLE) rarely causes atrioventricular (AV) conduction disorders in adults including first- and second-degree bundle branch blocks and complete heart block. This report will present a case of seconddegree AV block with anti-RNP and anti-Ro antibodies, an early sign of SLE, which improved with a standard dose of steroids. A fifty-nine-year-old woman presented with tiredness lasting for about one month. History did not reveal any cardiac illness. She was a non-smoker. On physical examination, she had a blood pressure of 120/80 mmHg, a rhythmic cardiac pulse of 62/min and a rhythmic radial pulse of 62/min. She had malar rash and oral aphthae. Cardiac oscultation did not reveal a cardiac murmur. Electrocardiography (ECG) showed Mobitz type I block, a second degree AV block. Antinuclear antibodies (1/1000) were in granular shape and anti-Sm and anti-Ro antibodies were positive. Anti-RNP antibodies (1/600) were also positive. The diagnosis of SLE was based on oral aphthae, malar rash, proteinuria and ANApositivity. Methyl prednison 1mg/kg was instituted. The patient noted that her fatigue subsided on the fifth day of the treatment and her ECG was normal. Although anti-Ro and anti-RNP antibodies are known to be positive in neonates with AV block, adults with anti-Ro and anti-RNP positivity should also be followed carefully for heart blocks.
Bookmark/Search this post with
Abstract (Original Language): 
Dal bloklar›, birinci, ikinci derece ve tam kalp blo¤unu içeren atriyoventriküler (AV) iletim bozuklu¤u, eriflkin sistemik lupus eritematozusta (SLE) nadiren görülür. Burada standart doz steroid ile düzelen SLE erken bulgusu olarak de¤erlendirdi¤imiz, Anti RNP, Anti-Ro antikorlar› pozitif 2. derece AV bloklu hastay› sunuyoruz. Ellidokuz yafl›nda bayan yaklafl›k 1 ayd›r olan yorgunluk yak›nmas› ile baflvurdu. Soy ve özgeçmiflinde kardiyak hastal›k dahil özellik tariflemiyordu. Sigara içmiyordu. Muayenesinde kan bas›nc› 120/80 mmHg, kardiyak nab›z 62/dk ritmik, radiyal nabz› 62/dk ritmik idi. Malar rash, oral aftlar› vard›. Kalp oskültasyonunda üfürüm duyulmad›. Elektrokardiyografisinde (EKG) 2. derece atriyoventriküler Mobitz tip 1 blok tespit edildi. Antinükleer antikor 1/1000 granüler paternde, anti Sm, Ro antikorlar› pozitif tespit edildi. Anti-RNP antikorlar› 1/600 oran›nda pozitifti. Oral aft, malar rash, proteinüri, ANApozitifli¤i ile SLE tan›s› kondu. Metil prednison 1mg/kg baflland›. Tedavinin 5 gününde yorgunlu¤u azalan hastan›n EKG’si normaldi. Özellikle neonatalde iyi bilindi¤i gibi anti-Ro, anti-RNP antikorlar› pozitif tespit edilen eriflkin hastalar kalp bloklar› aç›s›ndan takip edilmelidir.
FULL TEXT (PDF): 
PDF icon arastirmax-eriskin-sistemik-lupus-eritematozus-2.derece-atriyoventrikuler-blok.pdf
  • 3
105-107
  • Turkish

REFERENCES

References: 

1. Bilazarian SD, Taylor AJ, Brezinksi D, Hochberg MC, Guarnieri
T, Provost TT. High-grade atrioventricular heart block in an
adult with systemic lupus erythematosus: the association of nuclear
RNP (U1 RNP) antibodies, a case report, and review of the
literature. Arthritis Rheum. 1989; 32:1170-4.
2. Comin-Colet J, Sanchez-Corral MA, Alegre-Sancho JJ, Valverde
J, Lopez-Gomez D, Sabate X, Juan-Mas A, Esplugas E.
Complete heart block in an adult with systemic lupus erythematosus
and recent onset of hydroxychloroquine therapy.
Lupus. 2001; 10:59-62.
3. Costedout-Chalumeau N, Georgin-Levialle S, Amoura Z, Piette
JG. Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital
heart block. Lupus. 2005; 14:660-4.
4. Deng JS, Bair LW, Shen- Schwarz S, Ramsey-Goldman R,
Medsqer T. Localization of Ro (SS-A) antigen in the cardiac
conduction system. Arthritis Rheum. 1987; 30:1232-8.
5. Fonseca E, Crespo M, Sobrino JA. Complete heart block in an
adult with systemic lupus erythematosus. Lupus. 1994; 3:129-
31.
6. Godeau P, Guillevin L, Fechner J, Herreman G, Wechler B. Cardiac
involvement in systemic lupus erythematosus. 103 cases
(author's transl) Nouv Presse Med. 1981;10:2175-8.
7. Godeau P, Guillevin L, Fechner J, Bletry O, Herreman G. Disorders
of conduction in lupus erythematosus : frequency and incidence
in a group of 112 patients (author's transl).Ann Med Interne(
Paris)1981; 132:234-40.
8. Hahn BH. Systemic Lupus Erythematosus.In: Kasper D, Fauci
A, Longo DL, Braunwald E, Hauser SL, Jameson L.(eds). Harrison’s
principles of internal medicine.16 th ed. United States of
America, McGraw-Hill Companies, 2005; pp.1960-1967
9 Huo AP, Su KC, Liao HT, Chou CT, Chang HN. Second-degree
atriovenricular block as an early manifestation of adult systemic
lupus erythematosus. J Microbiol Immunol Infect. 2005; 38:
296-299.
10. James TN, Rupe CE, Monto RW. Pathology of the cardiac conduction
system in systemic lupus erythematosus.Ann Intern
Med. 1965; 63:402-10.
11. Liautaud S, Khan AJ, Nalamasu SR, Tan IJ, Onwuanyi AE. Variable
atrioventricular block in systemic lupus erythematosus.
Clin Rheumatol. 2005; 24: 162–165.
12. Lim LT, Joushua F. Resolution of complete heart block after
prednisolone in a patient with systemic lupus erythematosus. Lupus.
2005; 14:561-3.
13. Logar D, Kveder T, Rozman B, Dobovisek J. Possible association
between anti-Ro antibodies and myocarditis or cardiac conduction
defects in adults with systemic lupus erythematosus.
Ann Rheum Dis. 1990; 49:627–629
14. Martinez-Costa X, Ordi J, Barbera J, Selva A, Bosch J, Vilardell
M. High grade atrioventricular heart block in 2 adults with systemic
lupus erythematosus. J Rheumatol. 1991; 18:1926-8.
15. Meyer O. Anti-SSA/Ro and anti-SSB/La antibodies. What's
new? Ann Med Interne(Paris).2002; 153:520-9.
16. Moder KG, Miller TD, Tazelaar HD. Cardiac involvement in
systemic lupus erythematosus. Mayo Clin Proc. 1999; 74:275-
84.
17. O’Neill TW, Mahmoud A, Tooke A, Thomas RD, Madison PJ.
Is there a relationship between subclinical myocardial abnormalities,
conduction defects and Ro/La antibodies in adults with
systemic lupus erythematosus? Clin Exp Rheumatol
1993;11:409-12.
18. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield
NF, Schaller JG, Talal N, Winchester RJ. The 1982 revised criteria
for the classification of systemic lupus erythematosus. Arthritis
Rheum. 1982; 25:1271–1277.
19. Vinsonneau U. Delluc A, Bergez C, Caumes D, Talarmin F. Second
degree atrioventricular block in mixed connective tissue disease.
Rev Med Interne. 2005; 26:656-60.

Thank you for copying data from http://www.arastirmax.com