Early Onset Severe Aortic Stenosis Presenting with Recurrent Ventricular and Supraventricular Arrhythmia and Postoperative Stroke in a 44-year-old Man with Uncontrolled Rheumatoid Arthritis

Abstract

Calcific aortic stenosis is the most common aetiology of aortic stenosis and is mostly seen in older people. Systemic inflammatory diseases, such as rheumatoid arthritis (RA), are rarely associated with aortic stenosis in the literature. Uncontrolled systemic inflammation related to RA may lead to postoperative complications but this is not well documented. The patient in this case report was a 44-year-old man who had been diagnosed with RA that had been poorly controlled. He had a 7-month history of heart failure symptoms attributed to severe calcific aortic stenosis. He underwent surgical aortic valve replacement, but developed an acute cerebrovascular infarct 2 hours after surgery and recurrent unstable ventricular tachycardia on the first postoperative day warranting 15 synchronised cardioversions. RA is a rare antecedent cause of severe calcific aortic stenosis especially in younger people. Such a valvular complication associated with acute ischaemic stroke and ventricular arrhythmia warrants further study to provide optimal medical management, especially for patients with RA and early cardiovascular complications.