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Cardiopulmonary Lupus Complications


lupus heartCardiac abnormalities contribute significantly to morbidity and mortality in SLE and are among the most important clinical manifestations of the disease. In addition, involvement of the lungs and pleurae is common.

Potential Problems:

  • alterations in cardiac function
  • potential for impaired gas exchange and ineffective breathing patterns
  • alteration in tissue perfusion

Pericarditis, an inflammation of the pericardium, is the most common cardiac abnormality in SLE. Myocarditis, an inflammation of the heart muscle, may also occur, but is rare. Myocardial infarction, caused by atherosclerosis, is increased in SLE patients, even below the age of 35 years.

Pleuritic chest pain is common. Pleurisy is the most common respiratory manifestation in SLE. Attacks of pleuritic pain can also be associated with pleural effusions. Many patients complain of chest pain, but pericardial changes are not often demonstrated on clinical evaluation.

 

Summary of Potential Cardiopulmonary Lupus Complications

Pericarditis

  • pain in the anterior chest, neck, back, or arms that is often relieved by sitting up
  • shortness of breath
  • swelling of legs and feet
  • audible pericardial friction rub

Myocarditis

  • shortness of breath
  • fatigue
  • palpitations

Atherosclerosis Leading to Myocardial Infarction

Warning signs of myocardial infarction include:

  • burning, choking, squeezing, or pressing chest pain that may radiate to left shoulder and arm
  • shortness of breath
  • weakness
  • unrelieved indigestion
  • nausea and vomiting

Pleurisy

  • shortness of breath
  • chest pain, especially with deep inspiration

Leukocytoclastic Vasculltis

  • necrotic ulcerations, including raised hemorrhagic nodules (papule, purpura) that ulcerate, especially on the lower legs, ankles, and dorsa of the feet

Valvular Heart Disease (Libman-Sacks Lesions)

  • lesions that may result in cardiac murmurs and valve dysfunction; associated with APLs

Venous Thrombosis

  • positive Homans’ sign (pain associated with forced dorsiflexion of the ankle)
  • pain, swelling, inflammation, redness, and warmth in the affected limb
  • increased circumference of affected limb

Arterial Thrombosis

    • pain or loss of sensation due to ischemia in an extremity
    • paresthesias and loss of position sense
    • coldness
    • pallor
    • paralysis, loss of speech
    • no pulse in the extremity

lupus heart

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