View Full Version : Lupus and pericarditis

11-27-2001, 01:11 PM
Pericarditis is the inflamation of the sac enclosing the heart. The sypmtoms are long sustained periods of pain in the chest and the heart.

11-12-2003, 06:19 PM
I have Lupus and occationally I feel this hard to explain pain in my chest, I have had an EKG but the results were normal. I don't feel this pain all the time or even in coralation with any activities or feelings. Can anyone help me to understand this? :?

11-13-2003, 10:44 AM

The heart and the lungs are frequently affected in patients with Systemic Lupus Erythematosus (SLE). The degree of cardiopulmonary involvement ranges from no symptoms to life-threatening complications. In fact, heart disease is the third most common cause of death in people with SLE CARDIAC (HEART) INVOLVEMENT. Lupus can involve all parts of the heart including; the pericardium (sac surrounding the heart), myocardium (muscle layer), endocardium (lining of the inside of the heart) and the coronary arteries.

Pericarditis (inflammation of the sac around the heart) is the most common disease involving the heart in people with lupus. It occurs when the lining of the pericardium is attacked by autoantibodies and becomes inflamed. The usual symptoms include sharp chest pain underneath the sternum, fever, rapid heart beat and occasionally, shortness of breath. The pain can change with changes in position. Frequently, it is relieved by leaning forward slightly. The chest pain may feel like the pain associated with a heart attack. In some cases of pericarditis patients may have no symptoms. Blood tests, chest X-rays, an EKG, and an echocardiogram may be ordered to help diagnose pericarditis. The echocardiogram is an ultrasound of the heart and will tell the physician if there is fluid around the heart. In people with lupus, it is not uncommon to find an excess amount of fluid around the heart. Because pericarditis can be caused by conditions other than lupus, the cause must be determined before treatment begins. If pericarditis is caused by infection or kidney failure, the treatment is different than if it is due to lupus. Lupus pericarditis can be treated with antiŞinflammatory agents. If this form of therapy is unsuccessful, a brief course of corticosteroid treatment is usually needed.

When lupus causes inflammation of the myocardium, myocarditis occurs. Significant heart muscle disease is not common in SLE. The symptoms of myocarditis include: an unexplained rapid heart beat, an abnormal electrocardiogram, an irregular heart beat and heart failure. Myocarditis is frequently associated with inflammation of other muscles in the body. Treatment of lupus myocarditis usually includes corticosteroids. Immunosuppressive drugs (Cytoxan, Imuran) may be added if the inflammation is not completely controlled with steroids. Myocarditis can lead to tissue damage and replace heart tissue with scar tissue.

When lupus causes inflammation of the endocardium (endocarditis), the heart valves can be damaged, but it rarely effects the pumping efficiency of the heart. The surface of the valves may become thickened or develop wart-like growths called Libman-Sacks lesions. Although they may cause heart murmurs, it is uncommon for these growths to significantly affect the function of the valves. If bacteria lodge in the growths then infection (bacterial endocarditis) can occur. This too is uncommon, but potentially very serious and requires hospitalization. Rarely does the inflammation and scarring of valves lead to a deformity requiring valve replacement.

Finally, the coronary arteries can become prematurely narrowed in people with SLE. These arteries deliver blood and oxygen to the heart muscle and are vital to the heart's pumping function. Narrowing or blockage of an artery (coronary artery disease) can lead to chest pain and a heart attack. The narrowing of the coronary arteries in lupus may be due to inflammation of the artery wall (arteritis), cholesterol deposits inside the artery wall (atherosclerosis), or blood clots. Atherosclerosis is the most common cause of coronary artery disease in lupus. Research studies suggest that lupus patients receiving steroids have a higher risk of developing atherosclerosis. Prevention is the primary treatment of coronary artery disease. Controlling cardiac risk factors and lupus disease activity and carefully monitoring steroid use are required to prevent heart attacks in people with lupus.

The heart damage described can develop from the inflammation of active lupus or from medications. Treatment of cardiac problems must be individualized for each patient and each problem. Early and accurate diagnosis combined with aggressive therapy to reduce potential organ damage is the most significant consideration of lupus heart disease.

Lupus can involve the lung in many ways. Pleuritis (pleurisy) is the most common pulmonary manifestation of SLE. The pleura is a membrane that covers the outside of the lung and the inside of the chest cavity. It produces a small amount of fluid to lubricate the space between the lung and the chest wall. When this membrane is attacked by autoantibodies and becomes inflamed, it is called pleuritis. Sometimes, an excess amount of fluid can accumulate in the pleural space. This is called a pleural effusion and occurs less often than pleuritis. If the effusion is large enough, it can be seen on a chest x-ray. Since pleural effusions can be caused by infection or conditions other than lupus, the physician may need to take a sample of the fluid and perform tests to determine the cause.

Symptoms of pleuritis include severe, often sharp, stabbing pain that may be pin-pointed to a specific area or areas of the chest. The pain is often made worse by taking a deep breath, coughing, sneezing or laughing. Analgesics, non-steroidal anti-inflammatory drugs, and/or corticosteroids may be used to treat pleuritis. Pleural effusions will usually respond to these medications or clear by themselves with time.

Pneumonitis is inflammation within the lung tissue, which may be caused by an infection or by lupus. Infection is the most common cause of pneumonitis in people with lupus. Bacteria, viruses, fungi, or protozoa are organisms that can cause infection in the lung. Sometimes pneumonitis may occur without infection and is then called non-infectious pneumonitis. Since both forms of pneumonitis have the same symptoms; fever, chest pain, shortness of breath and cough, the patient is assumed to have an infection until proven otherwise. The diagnosis of pneumonitis requires blood tests, sputum tests and x-rays. Bronchoscopy and/or lung biopsy may also be necessary to determine if infection is the cause of the pneumonitis.

Treatment of pneumonitis initially includes a course of antibiotics. If laboratory and other diagnostic tests show no proof of infection, then the diagnosis is likely lupus pneumonitis. This non-infectious pneumonitis is treated with high doses of corticosteroids. Immunosuppressive drugs such as azathioprine (Imuran) may be added if the inflammation is not controlled with steroids.

Chronic diffuse interstitial lung disease is a relatively uncommon disorder in SLE. It is a chronic form of lupus pneumonitis and affects a relatively small number of people. The symptoms include a gradual onset of a chronic, non-productive cough; pleuritis-like chest pains; and difficulty breathing during physical activity. Diagnosis requires the exclusion of infection as a possible cause. Besides lupus, there are other causes of chronic diffuse interstitial lung disease. To determine the cause, special procedures such as bronchoscopy (visual inspection of the inside of the lungs) and/or lung biopsy are required. Correct identification of the cause is required to accurately select the proper treatment. Chronic lupus pneumonitis scars the lung and decreases the lungs' ability to deliver oxygen to the blood. The scarred lung tissue acts as a barrier to the oxygen which normally moves easily (diffuses) from the lung into the blood.

The severity and activity of this chronic disease can be measured and followed with pulmonary function testing (breathing tests). The diffusion capacity of the lung is a measurement of how readily oxygen moves through the lung and into the blood stream. It is usually reduced in chronic lupus pneumonitis. Periodic measurements of the diffusion capacity can indicate the response to treatment and enable the physician to follow the course of the disease. Chronic lupus pneumonitis is primarily treated with corticosteroids and patients will often have a variable response. The course of the disease also varies; some patients may slowly improve, stabilize, or deteriorate over time.

Occasionally, people with lupus develop pulmonary hypertension or high blood pressure in the blood vessels within the lung. If severe, it can be life-threatening and there tends to be little chance for improvement. There is no successful medical treatment for pulmonary hypertension. Heart-lung transplants may be an option for some patients with pulmonary hypertension caused by SLE.

Pulmonary involvement in lupus is not uncommon. Pleurisy and infection are the most common conditions involving the lung. The most common cause of pneumonitis in lupus patients is infection. Bacterial or viral pneumonitis are also common and all people with lupus who have a sudden onset of cough, fever or pleuritic chest pain should notify their physician.

Generally, the cardiopulmonary problems associated with lupus respond rapidly to treatment. But treatment must be tailored for each patient and problem. Again, the early and accurate diagnosis of problems and aggressive treatment to reduce potential organ damage are crucial to the successful management of cardiopulmonary disease in lupus.