Occurrence of the Wolff-Parkinson-White Syndrome Concomitant with Acute Rheumatic Fever *

Early descriptions of the Wolff-Parkinson-White syndrome emphasized its occurrence in the absence of demonstrable cardiac abnornalities.8' 7,1 Bishop remarked that the syndrome appeared occasionally in patients with hypertensive heart disease, acute glomerulonephritis, or inactive rheumatic heart disease, but felt that these factors were coincidental rather than caustive.2 However, a review of the literature and description of cases by Hunter et al., in 1940, indicated that cardiac abnormalities were not uncommon in this syndrome. They described its occurrence in the presence of old rheumatic and luetic valvular lesions, hypertension, myocardial infarction, and thyrotoxic heart disease; these conditions were present in 18 of the 90 cases reviewed in the literature, and in 3 of the 19 new cases reported by them.' Clagett reported a case in which the attacks of paroxysmal tachycardia were apparently precipitated by allergic reactions.4 Littman and Tarnower reported nine cases, in one of which hypertensive heart disease was suspected; it was the feeling of these authors that the syndrome might be occasioned by cardiac disease, and be transitory in nature in such instances.8 Graupera and Govea reported a case associated with the anginal syndrome.' Willius and Corryer, in 1946, reviewed 56 cases from their personal experience, and found that 19 of them had associated cardiovascular defects; 5 with healed rheumatic valvular disease; 4 with coronary artery disease and the anginal syndrome; 9 with hypertensive heart disease; and one with thyrotoxic heart disease and decompensation.'0 The appearance of this syndrome in association with acute rheumatic fever has not been noted in this country. In England, Hunter et al. reported two instances which occurred in conjunction with acute rheumatic fever: these authors noted that associated heart disease makes attacks of paroxysmal tachycardia less likely." Bain and Hamilton recorded a typical tracing in a rheumatic child.' Mahaim reported two