Six cases of congenital complete heart block followed for 34-40 years.

Abstract

The patients were respectively 12, 12, 12, 13, 20, and 27 years old when first seen. Four of them (Cases 2,3,4 and 7), now aged between 47 and 54, are leading normal, active lives and have hearts of normal size (average cardiothoracic ratio 47%). The only one (Case 4) who has ever had a Stokes-Adams attack had them frequently in infancy but only occasionally since (once after an interval of 19 years). Another (Case 7) changed from complete to latent heart block some time between the ages of 35 and 42, and for the past 12 years has had a P-R [pulse-rate] interval of from 0.32 to 0.48 sec, without any observed dropped beats. The 5th (Case 5) developed essential hypertension with a blood pressure of 260/120 mm Hg when she was 56, but still manages to run her home at the age of 67. The 6th (Case 8) had developed a large heart, left bundle-branch block, and some aortic regurgitation by the age of 32; and 16 years later was shown to have corrected transposition, a ventricular septal defect, and mitral and aortic regurgitation. Now aged 50, he needs treatment for his congestive heart failure. Of 8 other patients seen in 1948-54 with various cardiac malformations as well as heart block, which may or may not have been congenital, 6 have been traced. Only 2 are doing well and 4 have died during a few years follow-up. When complete heart block is congenital, the rate is faster, generally over 40 a minute, and can be increased more with exercise than when the block is acquired. There is some evidence that the stroke volume also can be increased with exercise more effectively. A patient with congenital complete heart block and no other abnormality should be allowed to lead a normal life, including strenuous occupations or games when so desired.