Full-blown rheumatoid heart and vessels associated with rheumatoid arthritis

Abstract

We report the case of a 54-year-old female patient with a history of rheumatoid arthritis (RA) who presented with dyspnea on exertion. Her pulsation on both arms was weak. Magnetic resonance (MR) angiography revealed Takayasu's arteritis (TA) characterized by multiple stenosis involving innominate, left common carotid, and left subclavian arteries. With regard to cardiac imaging, coronary computed tomography angiography revealed calcified stenosis of the left anterior descending and diagonal branch arteries, with an abdominal aorta narrowed concomitantly. Restrictive diastolic dysfunction with concentric hypertrophic myocardium was observed on echocardiography, and cardiac MR imaging revealed diffuse, subendocardial late gadolinium enhancement compatible with cardiac amyloidosis (CA). Herein, we describe a case of RA with “full-blown” complications of TA, CA, and coronary artery disease.