[Rheumatoid nodule and complete heart block: diagnosis by transesophageal echocardiography]

[Complete auriculoventricular block during chloroquine treatment]

INTRODUCTION

The cardiac toxicity of antimalarial agents is rare, it includes conduction disorders which can be complicated by third atrioventricular block and hypertrophic cardiomyopathy. We report two observations of patients who presented a complete heart block after several years of treatment by chloroquine.

CASE REPORT

Two patients followed for rheumatoid polyarthritis, treated by antimalarial agents for average 12 years and corticotherapy, presented a syncopal complete heart block which required an implantation of a pace maker. After having eliminated all the other underlying causes for complete heart block, the antimalarial agents were accused and were stopped. The clinical evolution after interruption of the treatment was favorable.

CONCLUSION

Our observations illustrate rare cardiac side effects observed in our two patients after long-term treatment by antimalarial agents. The diagnosis of antimalarial agents responsibility was retained on clinical and biological arguments after having eliminated the other causes. The insidious character of these complications imposes vigilance during the use of long-term treatment by antimalarial agents.

Echokardiographische Funktionsdiagnostik bei Patienten mit rheumatoider Arthritis und Kollagenosen

Cardiac manifestations were observed in patients with rheumatoid arthritis and other collagenoses. Echocardiography is a method of choice to detect pathologies in morphology and function of the heart. Pathophysiologically inflammatory alterations of the endo- as well as perimyocardium can be explained in these patients. In addition, in patients with collagenoses, the coagulation system is activated and the reactivity of the endothelium is reduced. Thus, thrombus formation at the heart valves with consecutive stenosis and/or regurgitations as well as ischemia-induced regional wall motion defects due to reduced vasodilator response of the coronary arteries can be expected. In the literature in patients with rheumatoid arthritis and other collagenoses, pericardial effusion and pulmonary hypertension are most frequently described. The echocardiographic analysis, however, is more complex due to the variability of the patient cohort. Quantification of valve defects and the analysis of wall motion and perfusion at rest and during stress is necessary to detect early changes of the diseases. The prerequisites for successful diagnostic echocardiography in these patients are the knowledge of modern echocardiographic techniques like tissue Doppler and contrast echocardiography and clinical experience with patients with rheumatoid arthritis and other collagenoses. The standardization of the echocardiographic diagnostic procedure becomes more and more important for reproducibility and comparability of the results.