This case report provides the first antemortem documentation of rheumatoid arteritis causing acute heart failure, diagnosed by myocardial biopsy and successfully treated with prednisone.
Suggests prednisone may resolve rheumatoid arteritis heart failure; hypothesis-generating and should not yet change practice.
A 49-year-old man with rheumatoid arthritis presented with acute congestive heart failure. Acute viral myocarditis was suspected clinically as a Gallium-67 myocardial scan was positive. Percutaneous catheter-directed biopsy of the right ventricular endomyocardium, however, revealed heavy endothelial deposits of IgM in the small blood vessels of the myocardium. Prednisone therapy resulted in normalization of both the myocardial Gallium-67 scan and left ventricular ejection fraction with resolution of the symptoms of congestive heart failure. This is the first report documenting rheumatoid arteritis antemortem by myocardial biopsy.
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Slack et al. (1986) studied this question.
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