Fatal heart block due to mesothelioma of the atrioventricular node

Our plain-English summary of Fatal heart block due to mesothelioma of the atrioventricular node, by D.W. Evans, P.G. Stovin (British Heart Journal, 1986).

The study

• Authors: D.W. Evans, P.G. Stovin
• Journal: British Heart Journal
• Published: 1986;56(6):572-4
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A fit young man of 23 was symptom free until the time of his death despite a narrow complex complete heart block, with resting heart rates down to 35 beats/min, that was first diagnosed when he was 10. The clinical diagnosis remained congenital heart block. Necropsy showed extensive infiltration of the atrioventricular node and proximal bundle by mesothelioma tissue. Pacing had not been advised because of his excellent exercise tolerance.

In plain English

This article was a case report about a young man who died suddenly at age 23. Complete heart block with narrow QRS complexes and a resting heart rate of 41 beats per minute was first reported when he was 10, and the clinical diagnosis remained congenital heart block. He had no symptoms, worked as a farm labourer and was used to strenuous exercise including football and wrestling. Pacing had not been advised because of his excellent exercise tolerance. In May 1985, a few minutes after loading a lorry with bales of straw, he complained of central chest pain and died. At necropsy (autopsy) the heart weighed 560 g and the left ventricle was hypertrophied. Under the microscope, gland-like mesothelioma tissue had extensively infiltrated the atrioventricular node and proximal bundle. The authors concluded that the death appeared consistent with ventricular tachycardia after strenuous exertion, and that it may be that pacing should have been offered. The article does not mention asbestos or any other exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient, with necropsy findings)
• Who was studied: One young man, followed from age 10 until his death at age 23 in May 1985, assessed at Papworth Hospital, Cambridge
• Main results:
  • Complete heart block with narrow QRS complexes and a resting heart rate of 41 beats per minute was first reported when the patient was 10 years old
  • On an electrocardiogram at age 20, the patient's ventricular rate was constant at 35 beats per minute
  • The patient was symptom free and very fit, working as a farm labourer, with no dizziness or effort-related symptoms at his last review in April 1985
  • In May 1985, three or four minutes after loading a lorry with straw bales, the patient complained of central chest pain and died
  • At necropsy the patient's heart weighed 560 g and the left ventricular free wall was 18 to 20 mm thick (hypertrophied)
  • Microscopy showed extensive infiltration of the patient's atrioventricular node and proximal bundle by gland-like mesothelioma tissue
• The authors' conclusion: The authors concluded that the death appeared consistent with ventricular tachycardia during recovery after strenuous exertion, and suggested that it may be that pacing should have been offered because of signs of left ventricular hypertrophy
• Limitations the authors state:
  • Electron microscopy was not done because of the interval between death and necropsy and because the heart had already been fixed in formol saline

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Autopsy.

Related studies

• "Mesothelioma of the atrioventricular node" with long-standing complete heart block. Report of a case — I.R. Wanless, B.W. Mielke, et al. (1975)
• Mesothelioma of the atrioventricular node and congenital complete heart block — R. Subramanian, B. Flygenring (1989)
• Mesothelioma of the atrioventricular node: first successful follow-up after excision — S. Balasundaram, S.A. Halees, et al. (1992)
• Atrioventricular block in childhood caused by mesothelioma — I.M. Hellemans, N.M. van Hemel, et al. (1981)
• Mesothelioma of the atrioventricular node — K. Nishida, G. Kamijima, et al. (1985)
• Congenital polycystic tumor of the atrioventricular node (endodermal heterotopia, mesothelioma): a histogenetic appraisal with evidence for its endodermal origin — G. Fine, U. Raju (1987)

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