Grand rounds from international lupus centres cardiac abnormalities in SLE: pancarditis

Many patients with systemic lupus erythematosus (SLE) develop cardiac manif estations during the course of their disease. Pericarditis is most commonly seen, with a reported prevalence of 60%. Myocardial involvement is present in only a minority of patients. In recent years, due to better noninvasive diagnostic techniques, valvular abnormalities can be demonstrated in an in creasing number of patients. Depending on the technique used, valvulopathy can be demonstrated in up to 77% of SLE patients. Although most of the valv ular lesions will be present without any symptoms, valve incompetence can r esult in congestive heart failure. Valvular lesions are associated with IgG anticardiolipin antibodies (aCL) and disease duration. We present a patien t with SLE and secondary antiphospholipid syndrome (APS) who developed acut e congestive heart failure due to pancarditis. Endocarditis, together with left ventricular dysfunction and pericardial effusion, were present. The en docarditis caused hemodynamically significant mitral valve insufficiency du e to thickening of the mitral cusps. Just two weeks prior to the occurrence of congestive heart failure echocardiography had been normal. Treatment wi th high dose corticosteroids resulted in a gradual, almost complete recover y. Literature concerning cardiac manifestations in lupus is reviewed.