One hundred consecutive female patients with active systemic lupus erythe matosus (SLE) were studied from the cardiovascular point of view by means of non invasive methods. Seventy percent of the cases presented some type of car diovascular anomaly. Seventy four percent of the resting electrocardiograms were abnormal as well as 72% of the M mode echocardiograms and 55% of the cardiac X ray series. The most frequent observed complications were: pericar ditis and or pericardial effusion (39%), arterial hypertension (22%), ischemic heart disease (16%), myocarditis (14%), congestive heart failure (10%), pulmo nary hypertension (9%), valvular heart disease (9%), pleural effusion (7%) and cerebro vascular accident (3%). We analized each one of these complications and found of special interest the high incidence of ischemic heart disease which is more frequent than has been hitherto reported. Ischemic heart disease was observed in two types of patients: a) Those with long term steroid therapy. In these, the mechanism seems to be an atherosclerotic disease probably induced by the chronic use of steroids. The management of these cases do not differ from other types of coronary heart disease due to atherosclerosis. b) Those with frank episodes of vasculitis in whom the basic mechanism is an inflammatory process of the coronary arteries and its treatment is fundamentally that of the vasculitis. We consider necessary to study routinely all patients with SLE through non invasive cardiological methods.
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References
1.
Dubois EL: Lupus Erythematosus. A review of the current status of discoid and systemic lupus erythematosus and their variants. Second Edition. New York, McGraw Hill, 1974.
2.
Harvey A., Shulman L., Thmulty P., et al: Systemic Lupus Erythematosus. A review of the literature and clinical analysis of 138 cases. Medicine33: 291, 1954.
3.
Mannik M., Gilliland B.: Systemic Lupus Erythematosus. In: Principles of Internal Medicine . Ninth Edition. Ed. by Harrison.New York, McGraw Hill, 1980, p. 355.
4.
Bulckley B., Humphries J.: The Heart and Collagen Vascular Diseases. In: The Heart. Fifth Edition. Ed. by Hurst JW.New York, McGraw Hill, 1982, p. 1567.
5.
Tan E., Cohen A., Fries J., et al: The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum25: 1271, 1982 .
6.
Feigenbaum H.: Echocardiography. Second Edition. Philadelphia, Lea and Febiger, 1976 , p. 419.
7.
Fishman A.: Cor Pulmonale. In: Principles of Internal Medicine. Ninth Edition. Ed. by Harnson. New York, McGraw Hill, 1980, p. 1136.
8.
Feigenbaun H.: Echocardiography. Second Edition. Philadelphia, Lea and Febiger, 1976 , p. 255.
9.
Perlroth M.: Connective tissue and the heart. JAMA231: 410, 1975 .
Elkayam U., Weiss S., Laniado S.: Pericardial effusion and mitral valve involvement in systemic lupus erythematosus. Echocardiographic study. Ann Rheum Dis36: 349, 1977.
16.
Bergen S.: Pericardial effusion a manifestation of systemic lupus erythematosus. Circulation22: 144, 1960.
17.
Bulkley B., Roberts W.: The heart in systemic lupus erythemaosus and the changes induced in it by corticosteroid therapy. A study of 36 necropsy patients. Am J Med58: 243, 1975.
18.
Kemplerer P. , Pollack A., Baehr G.: Pathology of disseminated lupus erythematosus . Arch Path32: 569, 1941.
19.
Dubois E.: Systemic Lupus Erythematosus: Recent advances in its diagnosis and treatment . Ann Intern Med45: 163, 1956.
20.
Larson D.: Systemic Lupus Erythematosus. Boston, Little, Brown and Co, 1961.
21.
Dubois E., Thffanelli D.: Clinical manifestations of systemic lupus erythematosus. JAMA190: 104, 1964.
22.
Aravanis C. , Toutozas P., Yatzidis I.: Fatal myocardial infarction in lupus erythematosus. Report of a case of a young female patient. Vascular Diseases1: 258, 1964.
23.
Tsakraklides V., Blieden L., Edwards J.: Coronary artherosclerosis and myocardial infarction associated with systemic lupus erythematosus. Am J Cardiol35: 309, 1975.
24.
Meller J., Conde C., Deppisch L., et al: Myocardial infarction due to coronary atherosclerosis in three young adults with systemic lupus erythematosus. Am J Cardiol35: 309, 1975.
25.
Bonfiglio T. , Botti R., Hagatrom J.: Coronary arteritis, occlusion and myocardial infarction due to lupus erythematosus. Am Heart J83: 153, 1972.
26.
Heibel R., O'Toole J., Curtiss E., et al: Coronary arteritis in systemic lupus erythematosus. Chest69: 700, 1976.
27.
Humpries E. : The cardiac lesions of acute diseminated lupus erythematosus. Ann Intern Med28: 12, 1948.
28.
Gobaira M., Zghaib A., Reyes R.: El corazón en el lupus eritematoso sistémico. Estudio en 32 pacientes no sistémicos . Arch Inst Cardiol Mex52: 223, 1982.
29.
Del Rio A., Vazquez J., Sobrino J., et al: Myocardial involvement in systemic lupus erythematosus. A non invasive study of left ventricular function. Chest74: 414, 1978.
30.
Sack K., Bekheist S., Faden S., et al: Severe pulmonary vascular disease in systemic lupus erythematosus . South Med J72: 1016, 1979.
31.
Schwartzberg M., Lieberman D., Getzoff B., et al: Systemic lupus erythematsus and pulmonary vascular hypertension. Arch Intern Med144: 605, 1984 .
32.
Libman E., Sacks B.: A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med33: 705, 1924.
33.
Bulkley B., Roberts W.: Systemic lupus erythematosus as a cause of severe mitral regurgitation. A new problem in an old disease. Am J Cardiol35: 305, 1975.
34.
Paget S., Bulkley B., Graver L., et al: Mitral valve disease of systemic lupus erythematosus: A cause of severe congestive heart failure reversed by valve replacement. Am J Med59: 134, 1975.
35.
Seningen R. , Borer J., Redwood D., et al: Libman-Sacks endocardoma: Diagnosis during life with radiographic, flouroscopic and angiocardiographic findings . Radiology113: 596, 1974.
36.
Beruhard G. , Lange R., Hensley G.: Aortic valvular insufficiency as the principal manifestation of systemic lupus erythematosus. Ann Int Med71: 81, 1969.
37.
Shulman H., Christian C.: Aortic insufficiency in systemic lupus erythematosus. Arth and Rheum12: 138, 1969.
38.
Vaughton K. , Walker D., Sturridge M.: Mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis. Brit Heart J41: 730, 1979.
39.
Pritzker M. , Ernst J., Caudill C., et al: Acquired aortic stenosis in systemic lupus erythematosus. Ann Int Med93: 434, 1980.
40.
Rawsthorne L., Ptacin M., Choi H., et al: Lupus valvulitis necessitating double valve replacement. Arth and Rheum24: 561, 1981.
41.
Mohr J., Fisher M., Adams R.: Cerebrovascular Diseases. In: Principles of Internal Medicine . Ninth Edition. Ed. by Harrison.New York, McGraw Hill, 1980, p. 1940.
