October 3, 2022

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How to deal with systemic lupus erythematosus heart damage?

How to deal with systemic lupus erythematosus heart damage?

 

How to deal with systemic lupus erythematosus heart damage?

Systemic lupus erythematosus can cause damage to the cardiovascular system, directly affect the quality of life and long-term prognosis of SLE patients, and may even be fatal.

 

Systemic lupus erythematosus (SLE) is a systemic chronic immune disease that often causes facial changes, erythema on both sides of the nose, or pain and swelling of the limbs and joints.

This disease mostly occurs in women of childbearing age.

The disease mainly affects multiple organs throughout the body, causing damage to important organ functions and even threatening the life and health of patients.

 

How to deal with systemic lupus erythematosus heart damage?

 

Because systemic lupus erythematosus (SLE) can threaten multiple organs throughout the body, the severity of the patient’s condition and symptoms vary, such as renal failure when the kidney system is damaged, or severe pulmonary hypertension when the lungs are affected Diseases such as pulmonary thrombosis, as well as diseases of the nervous, digestive, and blood systems, have caused great damage to the human body.

Some patients have external symptoms such as edema, general fatigue, fever, and weight loss.

 

In addition to the above symptoms, attacks of systemic lupus erythematosus on the cardiovascular system are not uncommon.

The heart is one of the most important organs of the human body. The degree of damage will directly affect the quality of life and long-term prognosis of SLE patients. It is fatal to SLE patients.

 

 

Therefore, today we will discuss SLE-related heart damage and some clinical treatment options.

 

1. Pericarditis

Pericarditis is the most common (25% or more), often associated with pleurisy.

Pericardial tamponade (1%) and constrictive pericarditis (1%~2%) are not common.

pericardiocentesis fluid is an exudate mainly composed of neutrophils.

Pericardial biopsy can see the deposition of monocytes, fibrin and immune complexes.

The treatment requires hormone therapy and pericardiocentesis if necessary.

 

2. Cardiomyopathy

Cardiomyopathy is related to hypertension/coronary artery disease (most common), antimalarial drugs, small vessel disease, microcirculation thrombosis.

The clinical manifestations of    myocarditis include tachycardia, fever, chest pain, and cardiac insufficiency.

Auxiliary examination of the patient showed abnormal echocardiography, a serum marker ECG, and T2 hyperintensity was visible in cardiac MRI.

Myocardial pathology showed inflammatory cell infiltration, perivascular inflammation, and myocardial cell necrosis.

Cardiac MRI can detect the patient’s cardiomyopathy more sensitively, better than echocardiography.

 

3. Coronary artery disease (CVD)

Studies have shown that the incidence of coronary events in SLE patients is significantly increased, and patients with renal disease are more likely to have atherosclerosis.

In addition, an epidemiological survey also showed that the time of the patient’s myocardial infarction was significantly related to SLE disease activity.

In terms of pathological mechanism, endothelial cell dysfunction, innate immune response disorder, acquired immune response disorder, autoantibodies, immune complex deposition, lipid metabolism, insulin resistance, etc. are involved in the occurrence of CVD.

 

4. Valve disease

The incidence rate is 12% to 73%, and the pathological changes mainly include valve thickening, regurgitation, and stenosis.

Age, thrombocytopenia, hypertension, antiphospholipid antibodies and valve disease are related, and patients with phospholipid antibodies and lupus anticoagulants are prone to abnormal pathophysiology of valve function.

 

5. Libman-Sacks endocarditis

In 1924, 4 patients with lupus reported verrucous growths on the posterior ventricular surface of the mitral valve.

neoplasms are composed of cellulose, necrotic tissue and monocytes. The mitral valve is the most common, followed by the aorta.

The incidence rate of is 11%~74%. It is more common in patients with phospholipid antibodies and subclinical.

Diagnosis needs to rely on pathological manifestations: neoplasms are composed of three layers, the outer layer includes fibrin, nuclear fragments and hematoxylin bodies; the middle layer includes fibroblasts and hyperplastic capillaries; the inner layer includes neovascularization, immunoglobulin and complement deposition.

Need to judge whether it is an infected or non-infected neoplasm for differential diagnosis.

In terms of treatment, hormone therapy has been significantly relieved. In terms of prognosis, vegetation shedding and embolism are not common, most of which do not affect heart function, and a few require valve replacement.

 

6. Arrhythmia

Sinus tachycardia or bradycardia is the most common, followed by atrial and ventricular premature contractions, atrial fibrillation, paroxysmal supraventricular tachycardia, atrioventricular block, left (right) bundle Branch block, but high-grade atrioventricular block is rare.

Arrhythmia caused by SLE may be related to the inflammatory response of SLE, vascular inflammation affecting the cardiac conduction system (sinus node or atrioventricular node).

The treatment of pregnant women with congenital atrioventricular block is mainly fluorinated glucocorticoids to eliminate the inflammatory response of the fetal cardiac conduction system and myocardium.

Plasma exchange and intravenous immunoglobulin therapy can also be considered.

 

7. Pulmonary hypertension

The pathogenesis is mainly due to the abnormal function of pulmonary artery endothelial cells, which leads to a decrease in diastolic vascular factors (NO, prostacyclin), and an increase in vasoconstrictor factors (endothelin), leading to chemotaxis of inflammatory cells.

Non-arterial factors include pulmonary interstitial disease, alveolar hemorrhage, cryptogenic organizing pneumonia and so on. Its response to immunotherapy and prognosis are good, and the condition is reversible.

 

 

 

 

How to deal with systemic lupus erythematosus heart damage?

(source:internet, reference only)


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