Lupus is a chronic inflammatory disease that occurs when the body's immune system attacks its own systems and organs. This inflammation can damage joints, skin, lungs, kidneys and the heart. Lupus can cause inflammation of the heart muscle, the arteries or the lining of the heart. Lupus also greatly increases the risk of cardiovascular disease and heart attacks, and can cause arrhythmias, or irregular heartbeats.
Pericarditis
Pericarditis is the inflammation of the thin sac-like membrane surrounding the heart called the pericardium. A 1985 article in the "Texas Heart Institute Journal" stated that acute lupus pericarditis is the most prevalent form of heart disease occurring in 30 to 40 percent of lupus patients. It is often associated with pericardial effusion, which is a collection of fluid in the pericardium. Lupus patients with pericarditis typically complain of left shoulder pain aggravated by deep breathing or lying down. The pain is classically relieved by sitting up and leaning forward. Treatment includes medications such as anti-inflammatory medications and steroids, and occasional removal of the pericardial effusion.
Endocarditis
Endocarditis is defined as an infection of the inner lining of the heart, says MayoClinic.com. Left untreated, endocarditis can damage or destroy the heart valves. A specific type of endocarditis caused by lupus is called Libman-Sacks. A study published in the "American Journal of Medicine" in 2007 found that Libman-Sacks endocarditis was present in approximately one in 10 lupus patients. The majority of patients had mitral valve involvement, with aortic valve involvement as the next most common issue.
Myocarditis
Myocarditis is defined by MayoClinic.com as an inflammation of the myocardium, or the middle layer of the heart wall. The "Texas Heart Institute Journal" reports that most cases of mycarditis are not found in lupus patients until autopsies are done; ultimately, it is found in 25 percent of lupus patient autopsies. Clinical diagnosis of lupus myocarditis is usually difficult unless the patient has symptoms. Diagnostic findings include shortness of breath, enlarged heart and EKG changes.
Arrhythmias
Pericarditis and myocarditis associated with lupus can lead to cardiac arrhythmias such as atrial fibrillation, ventricular arrhythmias and first-degree AV block. These abnormal heart rhythms may develop because the blood vessels that supply the heart's conduction system are inflamed, explains the "Texas Heart Institute Journal." "Rheumatology" reported in 2006 that in lupus patients, sinus tachycardia, atrial fibrillation and atrial ectopic beats are the major cardiac arrhythmias. They also state that small vessel vasculitis, infiltration of the sinus or AV nodes or active myocarditis in lupus can lead to first-degree AV block in 34 to 70 percent of patients.
Coronary Artery Disease
The "Texas Heart Institute Journal" states that arteritis and atherosclerosis can involve the coronary arteries of young lupus patients. A research study published by the Arthritis Foundation reported that women with lupus have a more than two-fold increased risk of cardiovascular disease over women without lupus. The research team determined that women with lupus are at 2.25 times the risk for coronary heart disease and 2.29 times the risk for stroke.
References
- MayoClinic.com: Lupus
- NCBI: "Texas Heart Institute Journal" Heart Disease in Systemic Lupus Erythematosus--Diagnosis and Management
- MayoClinic.com: Myocarditis
- "American Journal of Medicine"; Libman-Sacks Endocarditis; I. Moyssakis et al; 2007
- "Rheumatology"; Cardiac Arrhythmias and Conduction Disorders in Autoimmune Rheumatic Diseases; P. M. Seferovic; 2006
