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Myositis Cardiac Involvement — SCE Rheumatology MCQ

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HardMyositisMyositis Cardiac InvolvementSCE Rheumatology

A man with active inflammatory myopathy develops first-degree heart block followed by Mobitz I block. What complication should be suspected?

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Correct answer: A — Inflammatory myocardial involvement affecting the conduction system

The best answer is “Inflammatory myocardial involvement affecting the conduction system”. Idiopathic inflammatory myopathy can involve myocardium and the conduction system, producing arrhythmia, block or cardiomyopathy. The progressive block should not be dismissed as ageing, it does not prove coronary disease, glucocorticoid myopathy affects skeletal muscle rather than selectively causing AV block, and the abnormality is cardiac rather than peripheral.

Reference: BSR idiopathic inflammatory myopathy guideline: https://academic.oup.com/rheumatology/article/61/5/1760/6555980