Cardiovascular systemic lupus erythematosus

It is now understood that all three layers of the heart (pericardium, myocardium, and endocardium) can be involved by lupus. This chapter reviews not only the cardiac manifestations of active lupus, but also emphasizes on a growing source of morbidity and mortality in systemic lupus erythematosus (SLE) patients, accelerated atherosclerosis. Pericarditis is the most common cardiac manifestation of active lupus, although often it is not evident clinically. Pericarditis in SLE presents in the typical way, with precordial pain, usually positional (aggravated by lying down), often with a pleuritic quality, and sometimes with dyspnea. Other manifestation is pericardial effusion; when present, it is usually small and do not cause hemodynamic problems. Pericardial tamponade has been reported even in treated patients. The major challenge to clinicians is accelerated atherosclerosis, one of the major causes of mortality because it is often difficult to distinguish coronary arteritis from accelerated atherosclerosis. The differentiation of coronary arteritis from atherosclerosis is essential for appropriate management. Coronary artery bypass surgery, angioplasty, or stent placement would be considered in patients with severe atherosclerotic disease, but would be contraindicated in patients with coronary arteritis.