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Haemopericardium is rare in rheumatoid arthritis. We report a case of pericardial fluid and tumour compressing the right ventricle with Brugada-like ECG pattern in rheumatoid arthritis.
A 44 year old women who had rheumatoid arthritis for 10 years presented with dyspnoea. She was taking chloroquine 250 mg twice daily. On examination her heart rate was 85 beats/min. Jugular venous pressure was increased and a tender hepatomegaly was found. She was apyrexial with normal total and differential leucocyte count. An ECG showed regular rhythm with a pattern similar to those described in the Brugada syndrome (below left, panel A: right bundle branch block (RBBB) pattern with coved ST segment elevation in leads V1–V3). Echocardiography showed a pericardial effusion and a tumour compressing the right ventricle. A pericardial drain was inserted and 200 ml haemorrhagic fluid was drained, but the large pericardial mass did not disappear (below right). Microscopy and culture, including for acid-fast bacteria and cytology, were negative. During the operation macroscopic evidence revealed that the tumour was organised haemopericardium. After the operation the patient was well and had a normal ECG pattern (below left, panel B).
The diagnostic criteria for Brugada syndrome are rather uncertain. This report described a women in whom the mechanism for the RBBB pattern and ST segment elevation in the right precordial leads was probably the pericardial haematoma compressing the right ventricle.