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Rhythm and Conduction Disorders in Acute Rheumatic Fever

Yıl 2021, Cilt: 30 Sayı: 3, 127 - 136, 30.09.2021
https://doi.org/10.17827/aktd.866568

Öz

Acute rheumatic fever is a disease that is very common in developing countries. Heart involvement is responsible for morbidity and mortality. Mitral and aortic valve insufficiency and stenosis, congestive heart failure, myocarditis and pericarditis can be seen. Even if carditis does not develop during the course of the disease, many rhythm and conduction defects may occur. These include all degrees of atrioventricular block, sinus tachycardia and bradycardia, atrial and ventricular premature beats, accelerated junctional rhythm, supraventricular tachycardia, junctional and ventricular tachycardia. In this review, rhythm and conduction defects that may occur in acute rheumatic fever disease, which continues to be an important public health problem, were discussed in the light of the literature.

Kaynakça

  • 1. Eroğlu AG. Update on diagnosis of acute rheumatic fever: 2015 Jones criteria. Turk Ped Ars 2016;51:1-7.
  • 2. Szczygielska I, Hernik E, Kołodziejczyk B, Gazda A, Maślińska M, Gietka P. Rheumatic fever - new diagnostic criteria. Reumatologia 2018;56(1):37-41. 3. Güvenç O, Ergül Y. Akut romatizmal ateşte nadir görülen bir durum: Mobitz tip 1 II. derece AV blok. Çocuk Sağlığı ve Hastalıkları Dergisi 2017;60:16-8.
  • 4. Abdul Ghani OA, Singh D. Acute Rheumatic Carditis: A Rare Cause for Reversible Complete Heart Block. Hawaii J Med Public Health 2015;74(10):341-4.
  • 5. Sokolow M. Significance of electrocardiographic changes in rheumatic fever. Am J Med 1948; 5(3): 365-378. 6. Balli S, Oflaz MB, Kibar AE, Ece I. Rhythm and conduction analysis of patients with acute rheumatic fever. Pediatr Cardiol 2013;34(2):383-9.
  • 7. Filberbaum MB, Griffit GC, Solley RF, Leake WH. Electrocardiographic Abnormalities in 6,000 Cases of Rheumatic Fever. Cal West Med 1946;64(6):340-6.
  • 8. Clark M, Keith JD. Atrioventricular conduction in acute rheumatic fever. Br Heart Y 1972;34:472-9.
  • 9. Karacan M, Işıkay S, Olgun H, Ceviz N. Asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever: 24-hour electrocardiography study. Cardiol Young 2010;20:620-30.
  • 10. Ergül Y, Maraş H, Nişli K, Aydoğan Ü, Dindar A, Eker Ömeroğlu R. Akut romatizmal ateşte görülen ender bir ritim bozukluğu: Supraventriküler taşikardi. Çocuk Dergisi 2011;11(1):36-8. 
 11. Nişli K, Öner N, Dindar A, Caymaz C, Ertuğrul T. Akselere nodal ritim ile prezente olan akut romatizmal ateş vakası. Çocuk Dergisi 2008;8(1):57-9.
  • 12. Sokolow M. The electrocardiogram in the diagnosis and management of rheumatic fever. Calif Med 1947;66(4):221-6.
  • 13. Zalzstein E, Maor R, Zucker N, Katz A. Advanced atrioventricular conduction block in acute rheumatic fever. Cardiol Young 2003;13(6):506-8.
  • 14. Karacan M, Ceviz N, Olgun H. Heart rate variability in children with acute rheumatic fever. Cardiology in the Young 2012;22:285-92.
  • 15. Poudel CM, Gajurel RM, Barkoti M, Acharya SM, Anil OM. Complete heart block in acute rheumatic fever. Nepalese Heart Journal 2012;9:56-8.
  • 16. Nor Hidayah ZA, Azerin O, Mohd Nazri A. Complete heart block in young adult with acute rheumatic fever. Med J Malaysia 2018;73(5):323-5.
  • 17. Umapathy, S, Saxena A. Acute rheumatic fever presenting as complete heart block: report of an adolescent case and review
of literature. BMJ Case Rep 2018. doi:10.1136/bcr-2017-223792.
  • 18. Argun M, Baykan A, Özyurt A, Pamukçu Ö, Üzüm K, Narin N. Akut romatizmal ateşli olguda tam atriyoventriküler bloğa bağlı senkop ve geçici kalp pili ile tedavisi. Turk Pediatri Ars 2018;53(3):197-9.
  • 19. Reddy DV, Chun LT, Yamamoto LG. Acute rheumatic fever with advanced degree AV block. Clin Pediatr (Phila) 1989;28(7):326-8.
  • 20. Oba Y, Watanabe H, Nishimura Y, Ueno S, Nagashima T, Imai Y, et al. A case of adult-onset acute rheumatic fever with long-lasting atrioventricular block requiring permanent pacemaker implantation. Int Heart J 2015;56(6):664-7.
  • 21. Barold SS, Sischy D, Punzi J, Kaplan EL, Chessin L. Advanced atrioventricular block in a 39-year-old man with acute rheumatic fever. Pacing Clin Electrophysiol 1998;21:2025-8.
  • 22. Kula S, Olguntürk R, Ozdemir O. Two unusual presentations of acute rheumatic fever. Cardiol Young 2005;15(5):514-6.
  • 23. Hubail Z, Ebrahim IM. Advanced heart block in acute rheumatic fever. J Saudi Heart Assoc 2016;28(2):113-5.
  • 24. Olgun H, Ceviz N. Unusual rhythm problems in acute rheumatic fever: Two patient reports. Clin Pediatr 2004;43:197-9.
  • 25. Yoo GH. Complete atrioventricular block in an adolescent with rheumatic fever. Korean Circ J 2009;39:121-3.
  • 26. Kibar AE, Erdem s, Oflaz MB. A rare heart rhythm problem in acute rheumatic fever: Complete atrioventricular block. JCAM 2012. DOI: 10.4328/JCAM.1185
  • 27. Duran NE, Sönmez K, Biteker M, Ozkan M. A case of acute rheumatic fever presenting with syncope due to complete atrioventricular block. Anadolu Kardiyol Derg 2009;9(1):68-9.
  • 28. Shah CK, Gupta R. Persistent complete heart block following acute rheumatic fever in a 12 year old girl. J Assoc Physicians India 1993;41(6):389-90.
  • 29. Guven H, Özhan B, Bakiler AR, Salar K, Kozan M, Bilgin S. A case of Henoch-Schönlein purpura and rheumatic carditis with complete atrioventricular block. Eur J Pediatr 2006;165:395-7.
  • 30. Goel PK, Moorthy N, Bhatia T. Rheumatic severe mitral stenosis with complete heart block. Pediatr Cardiol 2013;34(7):1749-50.
  • 31. Malik JA, Hassan C, Khan GQ. Transient complete heart block complicating acute rheumatic fever. Indian Heart J 2002;54(1):91-2.
  • 32. Mohindra R, Pannu HS, Mohan B, Kumar N, Dhooria HS, Sehgal A, et al. Syncope in a middle aged male due to acute rheumatic fever. Indian Heart J 2004;56(6):668-9.
  • 33. Lenox CC, Zuberbuhler JR, Park SC, Neches WH, Mathews RA, Zoltun R. Arrhythmias and Stokes-Adams attacks in acute rheumatic fever. Pediatrics 1978;61(4):599-603.
  • 34. Woo KS. Stokes Adams attack as the first manifestation of acute rheumatic carditis. Int J Cardiol 1993;41:88-9.
  • 35. Carano N, Bo I, Tchana B, Vecchione E, Fantoni S, Agnetti A. Adams-Stokes attack as the first symptom of acute rheumatic fever: report of an adolescent case and review of the literature. Ital J Pediatr 2012 30;38:61.
  • 36. Cristal N, Stern J, Gueron M. Atrioventricular dissociation in acute rheumatic fever. British Heart Journal 1971;33:12-5.
  • 37. Yahalom M, Jerushalmi J, Roguin N. Adult acute rheumatic fever: a rare case presenting with left bundle branch block. Pacing Clin Electrophysiol 1990;13(1):123-7.
  • 38. Freed MS, Sacks P, Ellman MH. Ventricular tashycardia in acute rheumatic fever. Arch Intern Med 1985;145:1904-9.
  • 39. Kayali Ş, Doğan V, Keskin M, Yoldaş T, Kaya Ö, Özgür S, et al. Rhythm disturbances in the acute stage of acute rheumatic fever; report of four cases. Ann Pediatr Child Health 2015;3(6):1-4.
  • 40. Ceviz N, Celik V, Olgun H, Karacan M. Accelerated junctional rhythm in children with acute rheumatic fever: is it specific to the disease? Cardiol Young 2014;24:464-8.
  • 41. Bronshtein KhI, Itkin LE. A rare case of nodal rhythm associated with block of the bundle of His in rheumatic carditis. Vopr Revm 1965;5:94-7.
  • 42. Agnew J, Wilson N, Skinner J, Nicholson R. Beyond first-degree heart block in the diagnosis of ucute rheumatic fever. Cardiol Young 2019;29(6):744-748.
  • 43. Bansal N, Karpawich PP, Sriram CS. Junctional tachycardia in a child with non-rheumatic fever streptococcal pharyngitis. Cardiol Young 2017;27(5):985-989.
  • 44. Ramoğlu MG, Epçaçan S, Yeşilbaş O. Acute rheumatic fever presenting with severe endocarditis involving four valves, and ventricular tachycardia. Cardiol Young 2018;18:1. doi: 10.1017/S1047951118001671.
  • 45. Saraiva LR, Santos CL, de Aguiar IR. The prolongation of the QT interval in the acute rheumatic carditis: an enigma. Arq Bras Cardiol 2006;87:254-6.
  • 46. Liberman L, Hordof AJ, Alfayyadh M, Salafia CM, Pass RH. Torsade de pointes in a child with acute rheumatic fever. J Pediatr 2001;138:280-2.
  • 47. Tan KS, Lau YS, Teo WS. T wave alternans and acute rheumatic myocarditis: a case report. Ann Acad Med Singapore 1999;28(3):455-8.
  • 48. Kaul UA, Gambhir DS, Khalilullah M. Torsade de Pointes: manifestation of acute rheumatic carditis. Indian Heart J 1983;35(2):117-9. 49. Gimrikh EO, Popov SV, Pekarskiĭ VV. Electrocardiostimulation in the treatment of recurrent ventricular fibrillation in a patient with long QT syndrome on the ECG. Ter Arkh 1985;57:45-6.
  • 50. Remigio de Aguiar MI, Saraiva LC, Santos CL. QT dispersion predicting acute rheumatic carditis. Cardiol Young 2010;20:473-6.
  • 51. Aguiar MR, Ribeiro Saraiva LC, Santos CL QT dispersion predicting acute rheumatic carditis. Cardiol Young 2010;20:473-6.
  • 52. Alp H, Baysal T, Altın H, Karataş Z, Karaarslan S. QT and P-wave dispersions in rheumatic heart disease: prospective long-term follow up. Pediatr Int 2014;56(5):681-8.
  • 53. Polat TB, Yalçın Y, Akdeniz C, Zeybek C, Erdem A, Çelebi A. QT dispersion in acute rheumatic fever. Cardiol Young 2006;16:141-6.
  • 54. Hirsch JG, Flett DM. Sinus bradycardia in acute rheumatic fever. Ann Intern Med 1952;36:146-51.
  • 55. Grossman AM, Braybiel A. Sinus bradycardia in acute rheumatic fever; report of two cases. Arch Pediatr 1946;63:105-11.
  • 56. Ciftel M, Turan O, Simşek A, Kardelen F, Akçurin G, Ertuğ H. Assessment of atrial electromechanical delay in children with acute rheumatic fever. Cardiol Young 2014;24(1):27-32.
  • 57. Sharma SK, Verma SH. A clinical evaluation of atrial fibrillation in rheumatic heart disease. J Assoc Physicians India 2015;63(6):22-5.
  • 58. Orgun, Gursu HA, Cetin II. Wolff-Parkinson-White syndrome presenting with steroid-induced bradycardia in a patient with acute rheumatic fever. Cardiol Young 2018;2:1-3.

Akut Romatizmal Ateş Hastalığında Görülen Ritim ve İleti Bozuklukları

Yıl 2021, Cilt: 30 Sayı: 3, 127 - 136, 30.09.2021
https://doi.org/10.17827/aktd.866568

Öz

Akut romatizmal ateş, gelişmekte olan ülkelerde çok sık görülen bir hastalıktır. Morbiditeden ve mortaliteden kalp tutulumu sorumludur. Mitral ve aort kapağında yetmezlik ve darlık, konjestif kalp yetmezliği, miyokardit ve perikardit görülebilir. Hastalığının seyri sırasında kardit gelişmese bile birçok ritim ve ileti kusuru ortaya çıkabilir. Bunlar arasında her dereceden atriyoventriküler blok, sinüs taşikardisi ve bradikardisi, atriyal ve ventriküler erken atımlar, akselere nodal ritim, supraventriküler taşikardi, junctional ve ventriküler taşikardi sayılabilir. Bu derlemede, önemli bir halk sağlığı problemi olmaya devam eden akut romatizmal ateş hastalığında ortaya çıkabilen ritim ve ileti kusurları, literatür bilgileri eşliğinde tartışıldı.

Kaynakça

  • 1. Eroğlu AG. Update on diagnosis of acute rheumatic fever: 2015 Jones criteria. Turk Ped Ars 2016;51:1-7.
  • 2. Szczygielska I, Hernik E, Kołodziejczyk B, Gazda A, Maślińska M, Gietka P. Rheumatic fever - new diagnostic criteria. Reumatologia 2018;56(1):37-41. 3. Güvenç O, Ergül Y. Akut romatizmal ateşte nadir görülen bir durum: Mobitz tip 1 II. derece AV blok. Çocuk Sağlığı ve Hastalıkları Dergisi 2017;60:16-8.
  • 4. Abdul Ghani OA, Singh D. Acute Rheumatic Carditis: A Rare Cause for Reversible Complete Heart Block. Hawaii J Med Public Health 2015;74(10):341-4.
  • 5. Sokolow M. Significance of electrocardiographic changes in rheumatic fever. Am J Med 1948; 5(3): 365-378. 6. Balli S, Oflaz MB, Kibar AE, Ece I. Rhythm and conduction analysis of patients with acute rheumatic fever. Pediatr Cardiol 2013;34(2):383-9.
  • 7. Filberbaum MB, Griffit GC, Solley RF, Leake WH. Electrocardiographic Abnormalities in 6,000 Cases of Rheumatic Fever. Cal West Med 1946;64(6):340-6.
  • 8. Clark M, Keith JD. Atrioventricular conduction in acute rheumatic fever. Br Heart Y 1972;34:472-9.
  • 9. Karacan M, Işıkay S, Olgun H, Ceviz N. Asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever: 24-hour electrocardiography study. Cardiol Young 2010;20:620-30.
  • 10. Ergül Y, Maraş H, Nişli K, Aydoğan Ü, Dindar A, Eker Ömeroğlu R. Akut romatizmal ateşte görülen ender bir ritim bozukluğu: Supraventriküler taşikardi. Çocuk Dergisi 2011;11(1):36-8. 
 11. Nişli K, Öner N, Dindar A, Caymaz C, Ertuğrul T. Akselere nodal ritim ile prezente olan akut romatizmal ateş vakası. Çocuk Dergisi 2008;8(1):57-9.
  • 12. Sokolow M. The electrocardiogram in the diagnosis and management of rheumatic fever. Calif Med 1947;66(4):221-6.
  • 13. Zalzstein E, Maor R, Zucker N, Katz A. Advanced atrioventricular conduction block in acute rheumatic fever. Cardiol Young 2003;13(6):506-8.
  • 14. Karacan M, Ceviz N, Olgun H. Heart rate variability in children with acute rheumatic fever. Cardiology in the Young 2012;22:285-92.
  • 15. Poudel CM, Gajurel RM, Barkoti M, Acharya SM, Anil OM. Complete heart block in acute rheumatic fever. Nepalese Heart Journal 2012;9:56-8.
  • 16. Nor Hidayah ZA, Azerin O, Mohd Nazri A. Complete heart block in young adult with acute rheumatic fever. Med J Malaysia 2018;73(5):323-5.
  • 17. Umapathy, S, Saxena A. Acute rheumatic fever presenting as complete heart block: report of an adolescent case and review
of literature. BMJ Case Rep 2018. doi:10.1136/bcr-2017-223792.
  • 18. Argun M, Baykan A, Özyurt A, Pamukçu Ö, Üzüm K, Narin N. Akut romatizmal ateşli olguda tam atriyoventriküler bloğa bağlı senkop ve geçici kalp pili ile tedavisi. Turk Pediatri Ars 2018;53(3):197-9.
  • 19. Reddy DV, Chun LT, Yamamoto LG. Acute rheumatic fever with advanced degree AV block. Clin Pediatr (Phila) 1989;28(7):326-8.
  • 20. Oba Y, Watanabe H, Nishimura Y, Ueno S, Nagashima T, Imai Y, et al. A case of adult-onset acute rheumatic fever with long-lasting atrioventricular block requiring permanent pacemaker implantation. Int Heart J 2015;56(6):664-7.
  • 21. Barold SS, Sischy D, Punzi J, Kaplan EL, Chessin L. Advanced atrioventricular block in a 39-year-old man with acute rheumatic fever. Pacing Clin Electrophysiol 1998;21:2025-8.
  • 22. Kula S, Olguntürk R, Ozdemir O. Two unusual presentations of acute rheumatic fever. Cardiol Young 2005;15(5):514-6.
  • 23. Hubail Z, Ebrahim IM. Advanced heart block in acute rheumatic fever. J Saudi Heart Assoc 2016;28(2):113-5.
  • 24. Olgun H, Ceviz N. Unusual rhythm problems in acute rheumatic fever: Two patient reports. Clin Pediatr 2004;43:197-9.
  • 25. Yoo GH. Complete atrioventricular block in an adolescent with rheumatic fever. Korean Circ J 2009;39:121-3.
  • 26. Kibar AE, Erdem s, Oflaz MB. A rare heart rhythm problem in acute rheumatic fever: Complete atrioventricular block. JCAM 2012. DOI: 10.4328/JCAM.1185
  • 27. Duran NE, Sönmez K, Biteker M, Ozkan M. A case of acute rheumatic fever presenting with syncope due to complete atrioventricular block. Anadolu Kardiyol Derg 2009;9(1):68-9.
  • 28. Shah CK, Gupta R. Persistent complete heart block following acute rheumatic fever in a 12 year old girl. J Assoc Physicians India 1993;41(6):389-90.
  • 29. Guven H, Özhan B, Bakiler AR, Salar K, Kozan M, Bilgin S. A case of Henoch-Schönlein purpura and rheumatic carditis with complete atrioventricular block. Eur J Pediatr 2006;165:395-7.
  • 30. Goel PK, Moorthy N, Bhatia T. Rheumatic severe mitral stenosis with complete heart block. Pediatr Cardiol 2013;34(7):1749-50.
  • 31. Malik JA, Hassan C, Khan GQ. Transient complete heart block complicating acute rheumatic fever. Indian Heart J 2002;54(1):91-2.
  • 32. Mohindra R, Pannu HS, Mohan B, Kumar N, Dhooria HS, Sehgal A, et al. Syncope in a middle aged male due to acute rheumatic fever. Indian Heart J 2004;56(6):668-9.
  • 33. Lenox CC, Zuberbuhler JR, Park SC, Neches WH, Mathews RA, Zoltun R. Arrhythmias and Stokes-Adams attacks in acute rheumatic fever. Pediatrics 1978;61(4):599-603.
  • 34. Woo KS. Stokes Adams attack as the first manifestation of acute rheumatic carditis. Int J Cardiol 1993;41:88-9.
  • 35. Carano N, Bo I, Tchana B, Vecchione E, Fantoni S, Agnetti A. Adams-Stokes attack as the first symptom of acute rheumatic fever: report of an adolescent case and review of the literature. Ital J Pediatr 2012 30;38:61.
  • 36. Cristal N, Stern J, Gueron M. Atrioventricular dissociation in acute rheumatic fever. British Heart Journal 1971;33:12-5.
  • 37. Yahalom M, Jerushalmi J, Roguin N. Adult acute rheumatic fever: a rare case presenting with left bundle branch block. Pacing Clin Electrophysiol 1990;13(1):123-7.
  • 38. Freed MS, Sacks P, Ellman MH. Ventricular tashycardia in acute rheumatic fever. Arch Intern Med 1985;145:1904-9.
  • 39. Kayali Ş, Doğan V, Keskin M, Yoldaş T, Kaya Ö, Özgür S, et al. Rhythm disturbances in the acute stage of acute rheumatic fever; report of four cases. Ann Pediatr Child Health 2015;3(6):1-4.
  • 40. Ceviz N, Celik V, Olgun H, Karacan M. Accelerated junctional rhythm in children with acute rheumatic fever: is it specific to the disease? Cardiol Young 2014;24:464-8.
  • 41. Bronshtein KhI, Itkin LE. A rare case of nodal rhythm associated with block of the bundle of His in rheumatic carditis. Vopr Revm 1965;5:94-7.
  • 42. Agnew J, Wilson N, Skinner J, Nicholson R. Beyond first-degree heart block in the diagnosis of ucute rheumatic fever. Cardiol Young 2019;29(6):744-748.
  • 43. Bansal N, Karpawich PP, Sriram CS. Junctional tachycardia in a child with non-rheumatic fever streptococcal pharyngitis. Cardiol Young 2017;27(5):985-989.
  • 44. Ramoğlu MG, Epçaçan S, Yeşilbaş O. Acute rheumatic fever presenting with severe endocarditis involving four valves, and ventricular tachycardia. Cardiol Young 2018;18:1. doi: 10.1017/S1047951118001671.
  • 45. Saraiva LR, Santos CL, de Aguiar IR. The prolongation of the QT interval in the acute rheumatic carditis: an enigma. Arq Bras Cardiol 2006;87:254-6.
  • 46. Liberman L, Hordof AJ, Alfayyadh M, Salafia CM, Pass RH. Torsade de pointes in a child with acute rheumatic fever. J Pediatr 2001;138:280-2.
  • 47. Tan KS, Lau YS, Teo WS. T wave alternans and acute rheumatic myocarditis: a case report. Ann Acad Med Singapore 1999;28(3):455-8.
  • 48. Kaul UA, Gambhir DS, Khalilullah M. Torsade de Pointes: manifestation of acute rheumatic carditis. Indian Heart J 1983;35(2):117-9. 49. Gimrikh EO, Popov SV, Pekarskiĭ VV. Electrocardiostimulation in the treatment of recurrent ventricular fibrillation in a patient with long QT syndrome on the ECG. Ter Arkh 1985;57:45-6.
  • 50. Remigio de Aguiar MI, Saraiva LC, Santos CL. QT dispersion predicting acute rheumatic carditis. Cardiol Young 2010;20:473-6.
  • 51. Aguiar MR, Ribeiro Saraiva LC, Santos CL QT dispersion predicting acute rheumatic carditis. Cardiol Young 2010;20:473-6.
  • 52. Alp H, Baysal T, Altın H, Karataş Z, Karaarslan S. QT and P-wave dispersions in rheumatic heart disease: prospective long-term follow up. Pediatr Int 2014;56(5):681-8.
  • 53. Polat TB, Yalçın Y, Akdeniz C, Zeybek C, Erdem A, Çelebi A. QT dispersion in acute rheumatic fever. Cardiol Young 2006;16:141-6.
  • 54. Hirsch JG, Flett DM. Sinus bradycardia in acute rheumatic fever. Ann Intern Med 1952;36:146-51.
  • 55. Grossman AM, Braybiel A. Sinus bradycardia in acute rheumatic fever; report of two cases. Arch Pediatr 1946;63:105-11.
  • 56. Ciftel M, Turan O, Simşek A, Kardelen F, Akçurin G, Ertuğ H. Assessment of atrial electromechanical delay in children with acute rheumatic fever. Cardiol Young 2014;24(1):27-32.
  • 57. Sharma SK, Verma SH. A clinical evaluation of atrial fibrillation in rheumatic heart disease. J Assoc Physicians India 2015;63(6):22-5.
  • 58. Orgun, Gursu HA, Cetin II. Wolff-Parkinson-White syndrome presenting with steroid-induced bradycardia in a patient with acute rheumatic fever. Cardiol Young 2018;2:1-3.
Toplam 54 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Derleme
Yazarlar

Osman Güvenç 0000-0001-6590-6055

Yayımlanma Tarihi 30 Eylül 2021
Kabul Tarihi 22 Haziran 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 30 Sayı: 3

Kaynak Göster

AMA Güvenç O. Akut Romatizmal Ateş Hastalığında Görülen Ritim ve İleti Bozuklukları. aktd. Eylül 2021;30(3):127-136. doi:10.17827/aktd.866568