A Complete Atrioventricular Block Revealing Rheumatoid Arthritis: A Case Report

We report the case of a 66-year-old patient with cardiovascular risk factors: chronic smoking, diabetes and dyslipidemia. He went to the emergency room for syncope, with a complete atrioventricular block on the electrocardiogram. A transesophageal echocardiography performed as part of the workup shows a hyperechoic nodule located at the level of the interventricular. A transesophageal echocardiogram showed a hyperechoic nodule located at the level of the interventricular septum, which could correspond to a fibrous rheumatoid nodule and explain this atrioventricular block by the invasion of the conductive tissue. The patient was fitted with a definitive dual-chamber pacemaker. Conduction disorders in rheumatoid arthritis should be routinely detected in advanced rheumatoid arthritis. Transthoracic echocardiography is part of its workup. Transesophageal echocardiography may be necessary to detect fibrotic rheumatoid nodules.