Quadrivalvular rheumatoid heart disease associated with left bundle branch block

The clinical and necropsy findings are described in a sixty-five year old woman with rheumatoid arthritis and rheumatoid nodules in the heart, lungs, joints and subcutaneous tissue. Signs of aortic and mitral regurgitation, congestive cardiac failure and left bundle branch block were observed clinically and necropsy revealed numerous rheumatoid nodules in all four cardiac valves as well as in the adjacent myocardium and in the pericardium. The extensive nature of the cardiac involvement by rheumatoid granulomas is the most unusual aspect of this patient's illness.