Lupus: Support and Survival
Cardiopulmonary Disease And LupusThe heart and the lungs are frequently affected in patients with Systemic Lupus Erythematosus (SLE). The degree of cardiopulmonary involvement ranges from no symptoms to life threatening complications. In fact, heart disease is the third most common cause of death in people with SLE CARDIAC (HEART) INVOLVEMENT. Lupus can involve all parts of the heart including; the pericardium (sac surrounding the heart), myocardium (muscle layer), endocardium (lining of the inside of the heart) and the coronary arteries.
Pericarditis (inflammation of the sac around the heart) is the most common disease involving the heart in people with lupus. It occurs when the lining of the pericardium is attacked by autoantibodies and becomes inflamed. The usual symptoms include sharp chest pain underneath the sternum, fever, rapid heart beat and occasionally, shortness of breath.
The pain can change with changes in position. Frequently, it is relieved by leaning forward slightly. The chest pain may feel like the pain associated with a heart attack. In some cases of pericarditis patients may have no symptoms. Blood tests, chest X-rays, an EKG, and an echocardiogram may be ordered to help diagnose pericarditis. The echocardiogram is an ultrasound of the heart and will tell the physician if there is fluid around the heart.
In people with lupus, it is not uncommon to find an excess amount of fluid around the heart. Because pericarditis can be caused by conditions other than lupus, the cause must be determined before treatment begins. If pericarditis is caused by infection or kidney failure, the treatment is different than if it is due to lupus. Lupus pericarditis can be treated with anti-inflammatory agents. If this form of therapy is unsuccessful, a brief course of corticosteroid treatment is usually needed.
When lupus causes inflammation of the myocardium, myocarditis occurs. Significant heart muscle disease is not common in SLE. The symptoms of myocarditis include: an unexplained rapid heart beat, an abnormal electrocardiogram, an irregular heart beat and heart failure. Myocarditis is frequently associated with inflammation of other muscles in the body. Treatment of lupus myocarditis usually includes corticosteroids. Immunosuppressive drugs (Cytoxan, Imuran) may be added if the inflammation is not completely controlled with steroids.
Myocarditis can lead to tissue damage and replace heart tissue with scar tissue. When lupus causes inflammation of the endocardium (endocarditis), the heart valves can be damaged, but it rarely effects the pumping efficiency of the heart. The surface of the valves may become thickened or develop wart-like growths called Libman-Sacks lesions. Although they may cause heart murmurs, it is uncommon for these growths to significantly affect the function of the valves.
If bacteria lodge in the growths then infection (bacterial endocarditis) can occur. This too is uncommon, but potentially very serious and requires hospitalization. Rarely does the inflammation and scarring of valves lead to a deformity requiring valve replacement.
Finally, the coronary arteries can become prematurely narrowed in people with SLE. These arteries deliver blood and oxygen to the heart muscle and are vital to the heart's pumping function. Narrowing or blockage of an artery (coronary artery disease) can lead to chest pain and a heart attack.
The narrowing of the coronary arteries in lupus may be due to inflammation of the artery wall (arteritis), cholesterol deposits inside the artery wall (atherosclerosis), or blood clots. Atherosclerosis is the most common cause of coronary artery disease in lupus.
Research studies suggest that lupus patients receiving steroids have a higher risk of developing atherosclerosis. Prevention is the primary treatment of coronary artery disease. Controlling cardiac risk factors and lupus disease activity and carefully monitoring steroid use are required to prevent heart attacks in people with lupus.
The heart damage described can develop from the inflammation of active lupus or from medications. Treatment of cardiac problems must be individualized for each patient and each problem. Early and accurate diagnosis combined with aggressive therapy to reduce potential organ damage is the most significant consideration of lupus heart disease.
Contact the Lupus Foundation of America or the local Chapter that serves your area for more information about lupus, or the programs and services the LFA offers including support group information and physician referral.
Lupus Foundation of America., Inc.
1300 Piccard Drive, Suite 200
Rockville, MD 20850-4303
Information gathered from :
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