Acute Rheumatic fever (ARF) is commonly associated with
ECG abnormalities particularly atrioventricular block.
However, third degree atrioventricular block or complete
heart block is a rare manifestation. Most cases occurred in
children. We reported a 25 year old man who developed
complete heart block during an acute episode of ARF. He
presented to hospital with five days history of fever, malaise
and migrating arthralgia, followed by pleuritic chest pain.
One day after admission his electrocardiogram (ECG)
revealed complete heart block. Transthoracic
echocardiography showed good left ventricular function
with thickened, mild mitral regurgitation with minimal
pericardial effusion. ASOT titer was positive with elevated
white blood count and acute phase reactant. A temporary
pacemaker was inserted in view of symptomatic
bradycardia. The complete heart block resolved after
medical therapy. He was successfully treated with penicillin,
steroid and aspirin. He was discharged well with oral
penicillin. The rarity of this presentation is highlighted.