A 49-year-old man with rheumatoid arthritis presented with acute conges tive heart failure. Acute viral myocarditis was suspected clinically as a Gallium- 67 myocardial scan was positive. Percutaneous catheter-directed biopsy of the right ventricular endomyocardium, however, revealed heavy endothelial de posits of I gM in the small blood vessels of the myocardium. Prednisone therapy resulted in normalization of both the myocardial Gallium-67 scan and left ven tricular ejection fraction with resolution of the symptoms of congestive heart failure. This is the first report documenting rheumatoid arteritis antemortem by myocardial biopsy.
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