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Systemic Lupus Erythematosus
The Heart
Systemic Lupus Erythematosus
• Multisystem disease – Immune system– Constitutional – Fever; fatigue
– Skin and mucosa
– Joints
– Kidneys
– Heart
– Nervous system
– Blood
Systemic Lupus ErythematosusHeart
PericardiumPericarditisPericardial effusion
Pericardial tamponade Myocardium
Myocarditis Cardiomyopathy
EndocardiumValvular
Coronary artery diseaseVasculitis AtherosclerosisAntiphospholipid syndrome
Hypertension
Systemic Lupus Erythematosus
• Coronary Artery disease
– Risk Factors
•Male
• Age
• Family History
• Smoking
• High cholesterol
•SLE
Systemic Lupus ErythematosusCoronary Artery Disease
• Compared to the general population
– 50 times more common in premenopausal woman with lupus
– MI may the first presenting sign of CAD
– MI occurs at an earlier Mean age
• 49 compared to 69 in the general female population
Systemic Lupus ErythematosusChest pain
• Musculoskeletal– Trauma; muscle strain ;– Rib fracture
• Trauma or osteoporotic (steroids)
• Pericarditis• Pleuritis• Referred pain
– Abdomen eg. gall bladder– Nerve root– Cervical spine– Zoster
• Myocardial Infarction
Systemic Lupus ErythematosusPericarditis
May be the initial manifestation of SLE
Could be recurrent
Chest pain from mild to very severe
Increased with inspiration and bending forward
EKG abnormalities
Viral pericarditis usually preceded by URI
Systemic Lupus ErythematosusPericarditis Treatment
• Pericarditis– NSAID
• Indomethacin
• Narcotics
• Pericardial Effusion– Small
• no treatment
– Large • Trial of steroids
• Tamponade– pericardiocentesis
Systemic Lupus ErythematosusCardiomyopathy
• Unexplained Rapid heart rate
• Increasing shortness of breath
• Difficulty sleeping flat
• Cough
• Swollen feet
Systemic Lupus Erythematosus Cardiomyopathy
• Inflammatory
• Ischemic
• Others
– Drugs eg. Chloroquine
Systemic Lupus ErythematosusFatigue
Common symptom of
• Lupus
• Depression
• Ischemic heart disease
• Fibromyalgia
– Associated with poor sleep pattern
– Depression
– Multiple tender points
Systemic Lupus ErythematosusCoronary Artery Disease
• Diet
• Exercise
• Stop smoking
• Statins
• Hydroxychloroquine– Part of standard treatment of Lupus
• May prevent flares
– May reduce Cholesterol levels
• Keep steroids at the lowest possible dose
• Treatment of hypertension
Systemic Lupus ErythematosusEndocarditis
• Non Infectious
• Libman Sacks– Verrucous vegetations at the end of the valve
• Complement and fibrin deposition
• Associated with APL
– Mitral and aortic valve
– Rarely causes hemodynamic changes• Rupture of the chordae
• Thromboembolic phenomenon
Antiphospholipid Syndrome
• Recurrent spontaneous abortions
• Deep vein or arterial thrombosis
– Treatment includes life time anticoagulation