Rheumatoid heart disease

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Abstract

Rheumatoid heart lesions in several forms are encountered in patients with rheumatoid arthritis. The proposed incidence of this kind of heart disease is 27–34% of heart lesions in rheumatoid patients, and the involvement may assume any of the following forms: pericarditis, myocarditis, endocarditis with valvulitis, and coronary arteritis. Clinical features are nondiagnostic and include the presence of pericardial rub, chest pain, arrhythmias, murmurs, and signs of cardiac enlargement or failure (Table 3). Chest X-ray findings may reveal generalized cardiomegaly or selective unexplained atrial enlargement. Electrocardiographic findings are not specific for this entity and include ventricular enlargement or “strain” patterns and various conduction abnormalities. Proof positive of rheumatoid heart disease is the demonstration of cardiac granuloma histologically resembling a subcutaneous rheumatoid nodule. These granulomata are rare, and the common histologic findings are nonspecific. The clinical diagnosis of rheumatoid heart disease is therefore based on guilt by association and by exclusion of other common forms of heart disease.

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    1

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