Rheumatoid arthritis (RA) is a chronic autoimmune condition primarily known for causing inflammation in the joints, leading to pain, swelling, and stiffness. However, RA is a systemic disease, meaning its inflammatory processes can extend beyond the joints, affecting various organ systems throughout the body. The heart is a significant organ that can experience adverse effects due to this ongoing inflammation. This article explores how RA can impact cardiovascular health.
Ways Rheumatoid Arthritis Affects the Heart
Systemic inflammation inherent to rheumatoid arthritis contributes to various cardiovascular complications. One such complication is pericarditis, which involves inflammation of the pericardium, the fluid-filled sac surrounding the heart. This inflammation can lead to chest pain, and in some cases, pericardial effusion, where excess fluid accumulates around the heart, potentially impairing its function.
Inflammation can also target the heart muscle itself, a condition known as myocarditis. Myocarditis can weaken the heart’s pumping ability and lead to symptoms like fatigue or shortness of breath. Similarly, the inner lining of the heart and its valves can become inflamed, a condition termed endocarditis, which may result in valve damage and impaired blood flow.
Blood vessels throughout the body are also susceptible to inflammation, a condition called vasculitis. This can affect small to medium-sized arteries, potentially leading to reduced blood flow to various organs, including the heart. The most widespread cardiovascular impact of RA is accelerated atherosclerosis, a premature hardening and narrowing of the arteries. This process involves the buildup of plaque within arterial walls, significantly increasing the risk of heart attack and stroke.
Chronic inflammation in RA promotes endothelial dysfunction, a state where the inner lining of blood vessels does not function properly, contributing to plaque formation. The ongoing inflammatory burden also increases oxidative stress and dyslipidemia, further accelerating atherosclerosis. Consequently, individuals with RA face a higher risk of developing heart failure, a condition where the heart cannot pump enough blood to meet the body’s needs. This can result from prolonged inflammation-induced damage to the heart muscle or valves, or from severe atherosclerosis.
Arrhythmias, or irregular heartbeats, can also occur in individuals with RA. These irregularities may stem from inflammatory changes within the heart’s electrical conduction system or from structural damage caused by conditions like myocarditis or heart failure.
Spotting Heart-Related Symptoms
Recognizing heart-related symptoms in individuals with rheumatoid arthritis can be challenging, as some symptoms may overlap with RA itself or other common conditions.
Chest pain, for instance, might be a sign of pericarditis or angina, a type of chest discomfort caused by reduced blood flow to the heart.
Shortness of breath, especially during activity or when lying flat, can indicate heart failure or fluid accumulation around the heart.
Persistent fatigue, beyond what is typical for RA, along with swelling in the legs, ankles, or feet, may also suggest heart involvement, particularly heart failure.
Palpitations, which are sensations of a racing, pounding, or fluttering heart, can point to arrhythmias.
Dizziness or lightheadedness, especially when standing up, could be another indication of impaired heart function or an arrhythmia.
Prompt medical evaluation is important, as these symptoms can be subtle and may not always be attributed to the heart immediately.
Identifying Heart Involvement
Healthcare professionals employ a range of diagnostic tests to assess and confirm heart involvement in individuals with rheumatoid arthritis.
A thorough physical examination and detailed medical history are the first steps, allowing doctors to identify potential cardiovascular risk factors and symptoms.
Blood tests are frequently used to check for inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which indicate systemic inflammation.
Cardiac biomarkers, like troponin or B-type natriuretic peptide (BNP), can also be measured to assess heart muscle damage or heart failure.
An electrocardiogram (ECG or EKG) records the heart’s electrical activity, helping to detect arrhythmias or signs of past heart attacks.
An echocardiogram, an ultrasound of the heart, provides images of the heart’s structure and function, allowing assessment of valve health, pumping ability, and fluid around the heart.
For more detailed imaging, cardiac MRI or CT scans can offer comprehensive views of the heart muscle, pericardium, and blood vessels.
In specific situations, a stress test might be performed to evaluate how the heart performs under exertion.
Cardiac catheterization, an invasive procedure where a thin tube is inserted into a blood vessel and guided to the heart, may be necessary to directly visualize coronary arteries or measure pressures within the heart chambers.
Treating Heart-Related Complications
Managing heart-related complications in rheumatoid arthritis typically involves a two-pronged approach: controlling the underlying RA inflammation and addressing specific cardiac conditions. Medications that suppress the immune system, such as disease-modifying antirheumatic drugs (DMARDs) and biologic agents, are used to reduce systemic inflammation.
Specific medications are prescribed for cardiac conditions, depending on the diagnosis. Anti-inflammatory drugs may be used for pericarditis or myocarditis, while diuretics can help manage fluid retention in heart failure. Medications like ACE inhibitors, beta-blockers, and statins are commonly prescribed to manage blood pressure, heart rate, and cholesterol levels, particularly in the context of accelerated atherosclerosis.
Lifestyle modifications also play a significant role in improving cardiovascular health. Adopting a heart-healthy diet, engaging in regular physical activity, and quitting smoking are beneficial steps. Stress management techniques can also contribute to overall well-being. Regular monitoring and follow-up with both a rheumatologist and a cardiologist are important to ensure comprehensive and coordinated care.