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