[Rheumatoid nodule in the myocardium as part of the chain in a clinical detective. Case report]

The article describes a clinical case of a patient, at first glance healthy from the cardiovascular side, whose only complaint was ventricular extrasystole during exacerbations of arthritis. A typical scenario of such patients management is the suppression of the rheumatoid arthritis activity with the expectation that the involvement of target organs will subside accordingly. A rheumatoid nodule - specific manifestation of rheumatoid arthritis in the heart, that is usually detected in postmortem examinations and rare - according to echocardiography. Despite its small size (1.5×2 mm), the granuloma was the first clue to the patient's hidden heart condition. Further investigations revealed potential "killers" such as postinflammatory myocardial fibrosis, malignant ventricular arrhythmias, and coronary heart disease, prompting preventive measures. The case serves as an example of how, by pulling on the thread of a "clinically insignificant" finding, it is possible to identify a slowly progressing life-threatening pathology. The discussion of the case demonstrates an algorithm for making decisions about the management of cardiac arrhythmias in patients with rheumatic pathology, based on modern research methods and understanding of the complex mechanism of arrhythmias in inflammatory cardiomyopathy.