SLE and cardiovascular manifestations

http://cardiologysearch.blogspot.in/



Cardiac disease is common among patients with systemic lupus erythematosus (SLE) as

pericardial, myocardial, valvular and coronary artery involvement


Pericardial involvement is the Pericardial effusion

pericarditis

second most common echocardiographic lesion in SLE, and

most frequent cause of symptomatic cardiac disease.


Conduction defects,

Represent a sequel of active or past pericarditis and/or myocarditis

noted in 34 to 70 % of patients with SLE.

First-degree heart block may be seen and is often transient


Congenital heart block may be part of the neonatal lupus syndrome.

The resting heart rate may correlate with disease activity.

Study 14 of 15 patients with a resting heart rate above 90 beats/min had active disease


Mitral valve involvement is most common;

Mild to moderate regurgitant murmur may be heard but most patients remain asymptomatic

Mitral valve prolapse in 25 percent of cases.

Verrucous endocarditis — Libman-Sacks (verrucous) endocarditis


MYOCARDITIS

uncommon,

asymptomatic manifestation of SLE

prevalence of 8 to 25 % in different studies


Acute myocarditis

infiltration of the myocardium with mononuclear cells.

Resolution of the inflammation leads to fibrosis that may be manifested clinically as dilated cardiomyopathy.


1. Coronary artery involvement is the most recent cardiovascular manifestation to be recognized in SLE

2. seen in 2 – 16 % of patients with SLE 3. can lead to acute myocardial

infarction in young women.

In some cases, thrombi rather than coronary disease is responsible for the ischemia .

Coronary artery vasculitis is rare.


Other coronary artery manifestations -

Coronary arteritis,

Aneurysms,

Vasospasm

Embolic phenomenonhttp://cardiologysearch.blogspot.in/

Presentation

Angina,

Myocardial infarction,

Sudden death

Responsible for 0.3 % deaths.


Pathogenesis


RiskFactors


Most striking feature of CAD in SLE is the predilection for young premenopausal

women.

Manzi and colleagues lupus women aged 35 to 44 years were

over 50 times more likely to have an MI as compared to controls.


modifiable risk factor for occlusive vascular disease in both general and lupus populations.

Elevated homocysteine levels have been reported in 15% of lupus patients

Associated with cardiovascular events subclinical atherosclerosis


43 yr old female

A known case of SLE

ANA positive

On steroids


OBESITY

SYSTEMIC HYPERTENSION

ANEMIA

Acid peptic disease

Hypothyroidism

Nephropathy

Hemorrhoids


Old IWMI

CAG-2003 Mild CAD Mild LAD and RCA disease


Acute coronary syndrome

AWMI – delayed presentation

Not Thrombolised

Patient managed and stabilized

Taken for CAGhttp://cardiologysearch.blogspot.in/

Right dominant system

Two vessel disease

Significant proximal LAD disease

Critical mid RCA disease

Major diagonal diseasehttp://cardiologysearch.blogspot.in/

Hypokinetic IVS, apical segments. Anterolateral segments

Mild LV dysfunction

EF -65 %

Grade I – diastolic dysfunction


Advised

CABG SURGERY with grafts to Distal LAD Major diagonal Distal RCAORPCI to LAD and RCA- IF considered

high risk for CABGhttp://cardiologysearch.blogspot.in/

Discussed with CT surgeons and anesthetists

Due to Presence of high risk profile Symptomatic status – class III symptoms Nephropathy – high creatinine values, cr -

2.7 mg%

Patient taken for PCIhttp://cardiologysearch.blogspot.in/

Drug eluting stent placed in

LAD -SUPRALIMUS CORE STENT RCA - ENDEAVOR STENT

Patient was started on antiplatelets


Patient developed GI –bleeding

Coffee ground vomitting

Profound hypotension

Patient became unconscious


Blood transfusion

Fluid replacement

Inotrops – dopamine. Adrenaline infusion

started

Patient ABG - desaturationhttp://cardiologysearch.blogspot.in/

Patient connected to mechanical ventilator

Antiplatelets stopped- inspite of DES

Continuous Pantoprazole infusion started


Active bleeding stopped - after 3 days

Hemodynamic stability attained

CLOPIDOGREL antiplatelet- started after 3 days

Aspirin also restarted by 5 dayshttp://cardiologysearch.blogspot.in/

Patient improved in 5 days

Shifted to ward and discharged


Blood disorder NSAIDS – used for different symptoms in

SLE▪ Increase bleeding

Corticosteroids – produce peptic ulcer

Thrombocytopenia – increase bleeding▪ Autoimmune ▪ Drug induced

Antiphospholipid antibody – increase thrombosis▪ Increase chance of stent thrombosishttp://cardiologysearch.blogspot.in/

Bleeding Bleeding Stent

thrombosis

Anti platelets


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SLE and cardiovascular manifestations

Health & Medicine

Transcript of SLE and cardiovascular manifestations