Aborted sudden cardiac death in a young male with rheumatoid arthritis

Area of Science:

• Cardiology
• Rheumatology
• Vascular Biology

Background:

• Rheumatoid arthritis (RA) is a known risk factor for coronary artery atherosclerosis, comparable to diabetes and hypertension.
• Coronary artery disease (CAD), particularly chronic total occlusion (CTO), is uncommon in young individuals.
• RA is associated with increased plaque vulnerability and prothrombotic states.

Observation:

• A 26-year-old male with a 6-year history of RA presented with aborted sudden cardiac death.
• The patient had no cardiovascular risk factors other than RA.
• Multimodal evaluation revealed severe ischemic heart failure (HF) due to recent myocardial ischemia with CTO.

Findings:

• Despite RA treatment, the patient developed severe HF with CTO, indicating RA's potent role in CAD progression.
• This case underscores the potential for RA to be a primary driver of severe CAD in young patients.
• RA's association with vulnerable plaques and prothrombotic tendencies may contribute to CTO development.

Implications:

• RA should be considered a significant risk factor for CAD, including CTO, in young populations.
• Current RA treatments may not fully mitigate the cardiovascular risk in all patients.
• Further research is needed to understand and manage RA-associated cardiovascular complications, especially CTO in young adults.