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A Rare Case of Cardiac Tamponade Induced by Chronic Rheumatoid Arthritis

机译:罕见类风湿性关节炎引起的心脏填塞

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Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease primarily involving the joint synovium. RA is a systemic disease which has many known extra-articular manifestations. We present a unique case of a patient with long standing RA who presented with a primary complaint of chest and back pain. Echocardiography revealed borderline normal left ventricular function and a large pericardial effusion with the finding of elevated intrapericardial pressure suspicious for cardiac tamponade. Infectious workup was all found to be negative. The presence and elevation of anti-cyclic citrullinated peptide antibody, rheumatoid factor and C-reactive protein (CRP) confirmed the patient was having an active flare-up of RA. It was determined that this flare-up was the cause of the cardiac tamponade. A pericardiocentesis was performed and 850 mL of bloody fluid was drained. The patient remained stable following the pericardiocentesis. At his follow-up visit, repeat echocardiogram showed no signs for pericardial effusion. Although there has been extensive study of RA, there are only a few documented cases noting the occurrence of cardiac tamponade in these patients. Therefore, it is important for the clinician to be aware of and recognize this potentially serious cardiac outcome associated with a common rheumatologic condition.J Clin Med Res. 2015;7(9):720-723doi: http://dx.doi.org/10.14740/jocmr2226w
机译:类风湿关节炎(RA)是一种主要涉及关节滑膜的慢性炎性自身免疫性疾病。 RA是一种系统性疾病,具有许多已知的关节外表现。我们介绍了一个长期站立的RA患者的独特案例,该患者主要表现为胸部和背部疼痛。超声心动图检查显示左心室功能正常,并有大量心包积液,并发现心包压升高,可疑为心脏压塞。发现所有感染性检查均为阴性。抗环瓜氨酸肽抗体,类风湿因子和C反应蛋白(CRP)的存在和升高证实该患者患有活动性RA。可以确定,爆发是心脏压塞的原因。进行心包穿刺术,排出850 mL的血性液体。心包穿刺术后患者保持稳定。在他的随访中,重复的超声心动图检查未发现心包积液的迹象。尽管已经对RA进行了广泛的研究,但是只有少数文献记录的病例表明这些患者发生了心脏压塞。因此,对于临床医生而言,重要的是要意识到并认识到与常见风湿病相关的这种潜在的严重心脏预后。 2015; 7(9):720-723doi:http://dx.doi.org/10.14740/jocmr2226w

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