De subitaneis mortibus. XXIII. Rheumatoid arthritis and ankylosing spondylitis

Abstract

The conduction system of the heart was carefully examined at necropsy in 2 cases of rheumatoid arthritis and 1 of ankylosing spondylitis. All 3 patients had cardiac electrical instability and 2 of the 3 died suddenly. The electrophysiologic abnormalities of the 3 patients including paroxysmal atrial fibrillation in the first case, sustained atrial fibrillation with complete heart block and escape atrioventricular (A-V) junctional rhythm in the second case, and progressively increasing heart block eventually became complete in the third case. The sinus node exhibited extensive focal degeneration with and without associated inflammation in all 5 hearts, but the sinus node artery was not remarkably abnormal in any of these. All 3 hearts had important focal degenerative disease in the A-V node and His bundle, and in each of these there was marked narrowing of the local nutrient arteries, amounting to virtual occlusion in 2 hearts. The probable relation of these histologic findings to the electrocardiographic disturbances in each patient is discussed. Abnormalities in the cardiac conduction system of these 3 hearts are compared to ones previously reported for disseminated lupus erythematosus, polyarteritis nodosa, and scleroderma heart disease.