Complete heart block in children; report of three cases possibly attributable to measles.

Heart block, congenital or acquired, is an uncommon condition in childhood; as a sequel to measles it is extremely rare. The three cases bere reported are, therefore, of some interest, as in all three there is evidence ofcomplete heart block having developed either during or shortly after an attack of measles. Furthermore, although Case 1 has since died, all three survived the immediate effects of the development of heart block. White (1945) mentions congenital lesions, syphilis, diphtheria, rheumatism, bacterial endocarditis, and, very rarely, neoplasms, miliary tuberculosis, and trauma as causes of aunculo-ventricular block in the young. Seham (1925) in a review in Abt's ' Pediatrics ' summarizes thirty-two cases of heart block in children reported up to that date. Of these cases, ten were associated with congenital lesions, nine with diphtheria, and the remainder with a variety of conditions, among them one definitely and one doubtfully associated with measles, and one with measles and influenza. Bower (1939) describes two cases in adolescents, which he attributes to measles, but the association cannot be regarded as proved, for the attack of measles had occurred in one case ten years and in the other fourteen years before the heart block was discovered; in one case there had also been a severe attack of inmfluenza in the interval; furthermore there is no evidence that these cases were not congenital in origin. Logue and Hanson (1945) report a case of transient complete heart block in an American soldier during an attack of German measles which ran such an atypical course that the diagnosis must be rgarded as doubtful. According to Leys (1943), 'partial and trnset heart block is, ofcourse, common enough in the acute infections, but, if it should become complete, the patient usually dies.' This is certainly true of diphtheria, the acute infection most commonly associated with heart block, for all reports agree that survival for any length oftime after the development of complete heart block is unusual.