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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 Erythematosus


Heart
Pericardium
Pericarditis
Pericardial effusion
Pericardial tamponade
Myocardium
Myocarditis
Cardiomyopathy
Endocardium
Valvular
Coronary artery disease
Vasculitis
Atherosclerosis
Antiphospholipid syndrome
Hypertension

Systemic Lupus Erythematosus


Coronary Artery disease
Risk Factors
Male
Age
Family History
Smoking
High cholesterol
SLE

Systemic Lupus Erythematosus


Coronary 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 Erythematosus


Chest 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 Erythematosus


Pericarditis
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 Erythematosus


Pericarditis Treatment
Pericarditis
NSAID
Indomethacin
Narcotics

Pericardial Effusion
Small
no treatment
Large
Trial of steroids

Tamponade

pericardiocentesis

Systemic Lupus Erythematosus


Cardiomyopathy
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 Erythematosus


Fatigue
Common symptom of
Lupus
Depression
Ischemic heart disease
Fibromyalgia
Associated with poor sleep pattern
Depression
Multiple tender points

Systemic Lupus Erythematosus


Coronary 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 Erythematosus


Endocarditis
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