Rheumatol Int (2012) 32:461–464 DOI 10.1007/s00296-009-1318-4 123 CASE REPORT Cardiac complications in rheumatoid arthritis in the absence of occlusive coronary pathology Armen Yuri Gasparyan · Giuseppe Cocco · Stefano PandolW Received: 25 October 2009 / Accepted: 29 November 2009 / Published online: 20 December 2009  Springer-Verlag 2009 Abstract Cardiovascular disease is the leading cause of premature mortality in patients with rheumatoid arthritis (RA). Pathophysiology of rheumatoid cardiovascular phe- nomenon is not fully understood, but systemic inXamma- tion is thought to play a crucial role in the endothelial damage and accelerated course of atherosclerotic disease. Rheumatoid inXammation can also cause coronary pathol- ogy and heart failure. We present a case of transient cardio- myopathy in RA in the absence of occlusive coronary pathology, which mimics acute coronary syndrome. Keywords Rheumatoid arthritis · InXammation · Cardiomyopathy · Coronary arteries Introduction Cardiovascular disease (CVD) is the leading cause of pre- mature mortality in patients with rheumatoid arthritis (RA), who are at increased risk of ischemic heart disease (IHD) and heart failure [1]. Established cardiovascular risk factors account for the excessive mortality in this population of patients. However, it has been increasingly recognized that systemic inXammatory burden is a more important factor predisposing to endothelial dysfunction, accelerated athero- sclerosis, and associated vascular events in RA [2–4]. Precise inXammation-mediated mechanisms of rheuma- toid vasculopathy are still poorly understood and cardiovas- cular preventive measures are not properly identiWed. Interestingly, available pathomorphological evidence sug- gests that occlusive atherosclerotic coronary pathology rarely contribute to cardiovascular mortality in RA [5, 6], and it is likely that systemic rheumatoid inXammation pre- disposes to a variety of coronary manifestations (e.g., coro- naritis, vasospasm, and microvascular disease), which may destabilize atherosclerotic coronary disease in stress-asso- ciated conditions. Investigation of these conditions and their potential association with cardiovascular morbidity and mortality in RA merits further investigation. We herein present a case of cardiomyopathy in RA in the absence of angiographically evident coronary abnormali- ties. Case presentation A 52-year-old Caucasian female patient with Mediterra- nean ancestries (height 154 cm and weight 52 kg) was diag- nosed with RA based on the American College of Rheumatology (ACR) 1987 criteria [7]. She presented with severe arthritic involvement of the hands, elbows, and knees. She was positive for anti-cyclic citrullinated peptide (anti-CCP) antiboides. C-reactive protein (CRP) and eryth- rocyte sedimentation rate (ESR) were elevated (6.6 mg/dL and 44 mm/h, respectively). The patient received treatment with non-steroidal anti-inXammatory drugs (NSAIDs), A. Y. Gasparyan Department of Rheumatology, Russell’s Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, West Midlands, UK e-mail: a.gasparyan@gmail.com G. Cocco (&) Cardiology OYce, POB 119, Marktgasse 10A, 4310 Rheinfelden 1, Switzerland e-mail: praxis@cocco.ch S. PandolW Rheumatology OYce, Muttenz, Switzerland e-mail: pandolfi@gmail.com