In what ways can the heart be involved in SLE?
• Pericarditis: When symptomatic, can be associated with a left-sided pleural effusion. Colchicine may be an effective treatment. An asymptomatic pericardial effusion can be seen on echocardiogram.
• Myocarditis: Rare. Presents as heart failure or unexplained tachycardia. Obtain a myocardial biopsy if possible. Troponin is elevated.
• Vasculitis: (coronary): Rare.
• Secondary atherosclerotic coronary artery disease and myocardial infarction: Very common especially later in disease.
• Secondary hypertensive disease: From steroids or renal insufficiency.
• Medication effects: Hydroxychloroquine can cause a cardiomyopathy.
• Valvular disease: More frequent in patients with antiphospholipid antibodies. However, anticoagulation or glucocorticoids do not prevent destruction of the valve. Thickening of aortic and mitral valves is seen.
• Libman–Sacks verrucae occur most commonly on the ventricular side of the posterior leaflet of mitral valve or on aortic valve. May cause embolic stroke. Transesophageal echo is more sensitive than transthoracic. There is an increased risk of subacute bacterial endocarditis due to immunosuppression.