Acute on chronic severe aortic insufficiency due to rheumatoid arthritis-associated valvulitis.

• Type of Material: Article
• Authors: Kendra Ivy, Morehouse School of Medicine; Obiora Egbuche, Morehouse School of Medicine; Sartaj Gill, Morehouse School of Medicine; Kenechukwu Mezue, Massachesetts General Hospital; Shirley I Nwokike, Medical College of Georgia; Pradhum Ram, Emory University; Temidayo Abe, Morehouse School of Medicine; Ifeoma Onuorah, Emory University; Melvin Echols, Morehouse School of Medicine
• Language: English
• Date: 2021
• Publisher: AJCD
• Publication Version: Final Published Version
• Copyright Statement: © AJCD 2021
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Title of Journal or Parent Work: Am J Cardiovasc Dis
• Volume: 11
• Issue: 3
• Start Page: 404
• End Page: 409
• Keywords: aortic insufficiency; valvular destruction; heart failure; Rheumatoid arthritis
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Rheumatoid Arthritis associated valvular heart disease (RA-VHD) may occur in patients in varying degrees of severity. Aortic valve involvement leading to severe symptomatic aortic insufficiency is a rare complication of rheumatoid arthritis. This entity has not been well characterized and its clinical predictors are undefined. The pathology of RA-VHD can extend from benign nodular development to acute valvulitis with late-stage leaflet fibrosis and severe valvular regurgitation. In this report, we describe a rare case of acute heart failure (AHF) resulting from severe aortic valve destruction and insufficiency due to persistent chronic inflammation in a patient with long-standing RA. Persistent systemic inflammation of RA involved the aortic valve causing nodular thickening and leaflet destruction. Our patient had compensated chronic heart failure due to progressive aortic insufficiency resulting from gradual leaflet destruction. However, she suddenly developed AHF requiring valve replacement. Her clinical presentation, gross and histological images suggest an acute/subacute disruption of the friable aortic leaflets that resulted in AHF.