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Complete heart block in rheumatoid arthritis.
Annals of the Rheumatic Diseases
|August 1, 1983
Summary
Rheumatoid arthritis can cause complete heart block (CHB), often in patients with severe disease. Pacemaker insertion is recommended for symptoms like syncope, with a good prognosis if other cardiac issues are absent.
Area of Science:
- Cardiology
- Rheumatology
- Pathology
Background:
- Rheumatoid arthritis (RA) is a systemic autoimmune disease.
- Cardiac involvement in RA can range from pericarditis to conduction abnormalities.
- Complete heart block (CHB) is a rare but serious cardiac manifestation of RA.
Observation:
- This study reports 8 new cases of CHB in RA patients, reviewing 20 previously documented cases.
- CHB in RA typically occurs in patients with established erosive nodular disease.
- While often sudden, CHB can progress from earlier conduction delays.
Findings:
- The hallmark histopathological finding is the presence of rheumatoid granulomas in the atrioventricular (AV) node or bundle of His.
- Syncope and Stokes-Adams attacks are critical indicators for intervention.
Implications:
- Insertion of a permanent pacemaker is the primary treatment for symptomatic CHB in RA patients.
- Prognosis for CHB in RA is generally favorable, contingent on the absence of other cardiac lesions (pericardial, valvular, myocardial).
- Understanding the link between RA and CHB aids in early diagnosis and management of cardiac complications in RA patients.