EJMCR. 2018; 2(3): 121-125

Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report

Authors: Giuseppe Cocco.

ABSTRACT

Background: Rheumatoid arthritis (RA) is an immune-related inflammatory disease which affects almost 1% of the general population and which is ranked among the top 15% of diseases causing major disability worldwide. RA shares some pathologic features, genetic predisposition, and risk factors with atherosclerosis, and inflammation plays a central pathophysiologic role in both diseases. RA is associated with an increased risk of cardiovascular mortality. In RA, pericardial involvement is a frequent complication but rarely occurs as the first manifestation. Case Presentation: A 63-year-old male patient with RA presented with an acute chest pain and in the Electrocardiography (ECG) ischemic ST-down-sloping in multiple leads. Echocardiography showed an abnormal “bounce” of the interventricular septum and a small-medium size pericardial effusion. The laboratory values showed high inflammatory parameters and confirmed the presence of active RA. Troponin T was normal and NT-proBNP was at level 2. There were no signs for vasculitis. Coronarography found only small non-stenotic changes in the coronary arteries. A rheumatologic consultant recommended prednisone and later on, tocilizumab. He was also treated with colchicine. The clinical condition improved within 2 weeks and the ECG changes normalized within a month. Three months later, an echocardiographic follow-up showed that the pericardial effusion and the left ventricular bounce had disappeared. Conclusion: Small-medium size pericardial effusion manifesting as an acute coronary syndrome and with ischemic ECG changes is the most unusual finding. Indeed, the proper diagnosis of a pericardial effusion was made retrospectively

Keywords:
Pericardial effusion, rheumatoid arthritis, acute chest pain, atypical ECG changes.


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Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report


Authors
Giuseppe Cocco
Cardio-Rheumatology Office, Marktgasse, Rheinfelden, Switzerland
PubMed articlesGoogle scholar articles


Correspondence to:
. Cardio-Rheumatology Office, Marktgasse, Rheinfelden, Switzerland; praxis@cocco.ch

Publication history
Received 04 Jul 2018
Revised 16 Sep 2018
Accepted 02 Oct 2018
Published in print 12 Oct 2018

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Pubmed Style

Giuseppe Cocco. Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report. EJMCR. 2018; 2(3): 121-125. doi:10.24911/ejmcr/173-1530701583


Web Style

Giuseppe Cocco. Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report. http://www.ejmcr.com/?mno=302642821 [Access: November 15, 2018]. doi:10.24911/ejmcr/173-1530701583


AMA (American Medical Association) Style

Giuseppe Cocco. Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report. EJMCR. 2018; 2(3): 121-125. doi:10.24911/ejmcr/173-1530701583


Vancouver/ICMJE Style

Giuseppe Cocco. Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report. EJMCR. (2018), [cited November 15, 2018]; 2(3): 121-125. doi:10.24911/ejmcr/173-1530701583


Harvard Style

Giuseppe Cocco (2018) Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report. EJMCR, 2 (3), 121-125. doi:10.24911/ejmcr/173-1530701583


Turabian Style

Giuseppe Cocco. 2018. Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report. European Journal of Medical Case Reports, 2 (3), 121-125. doi:10.24911/ejmcr/173-1530701583


Chicago Style

Giuseppe Cocco. "Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report." European Journal of Medical Case Reports 2 (2018), 121-125. doi:10.24911/ejmcr/173-1530701583


MLA (The Modern Language Association) Style

Giuseppe Cocco. "Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report." European Journal of Medical Case Reports 2.3 (2018), 121-125. Print. doi:10.24911/ejmcr/173-1530701583


APA (American Psychological Association) Style

Giuseppe Cocco (2018) Unusual electrocardiographic changes in a patient with pericardial effusion caused by rheumatoid arthritis: a case report. European Journal of Medical Case Reports, 2 (3), 121-125. doi:10.24911/ejmcr/173-1530701583


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