SLE and cardiovascular manifestations

1,663 views
1,391 views

Published on

for more cardiology ppts visit regularly

Published in: Health & Medicine, Technology
2 Comments
4 Likes
Statistics
Notes
No Downloads
Views
Total views
1,663
On SlideShare
0
From Embeds
0
Number of Embeds
60
Actions
Shares
0
Downloads
80
Comments
2
Likes
4
Embeds 0
No embeds

No notes for slide

SLE and cardiovascular manifestations

  1. 1. http://cardiologysearch.blogspot.in/http://cardiologysearch.blogspot.in/ http://cardiologysearch.blogspot.in/
  2. 2.  Cardiac disease is common among patients with systemic lupus erythematosus (SLE) as  pericardial,  myocardial,  valvular and  coronary artery involvement http://cardiologysearch.blogspot.in/
  3. 3. http://cardiologysearch.blogspot.in/
  4. 4. http://cardiologysearch.blogspot.in/
  5. 5. http://cardiologysearch.blogspot.in/
  6. 6.  Pericardial involvement is the  Pericardial effusion  pericarditis  second most common echocardiographic lesion in SLE, and  most frequent cause of symptomatic cardiac disease. http://cardiologysearch.blogspot.in/
  7. 7.  Conduction defects, Represent a sequel of active or past pericarditis and/or myocarditis noted in 34 to 70 % of patients with SLE. First-degree heart block may be seen and is often transient http://cardiologysearch.blogspot.in/
  8. 8.  Congenital heart block may be part of the neonatal lupus syndrome. The resting heart rate may correlate with disease activity. Study 14 of 15 patients with a resting heart rate above 90 beats/min had active disease http://cardiologysearch.blogspot.in/
  9. 9.  Mitral valve involvement is most common; Mild to moderate regurgitant murmur may be heard but most patients remain asymptomatic Mitral valve prolapse in 25 percent of cases. Verrucous endocarditis — Libman-Sacks (verrucous) endocarditis http://cardiologysearch.blogspot.in/
  10. 10.  MYOCARDITIS  uncommon,  asymptomatic manifestation of SLE  prevalence of 8 to 25 % in different studies http://cardiologysearch.blogspot.in/
  11. 11.  Acute myocarditis infiltration of the myocardium with mononuclear cells. Resolution of the inflammation leads to fibrosis that may be manifested clinically as dilated cardiomyopathy. http://cardiologysearch.blogspot.in/
  12. 12. 1. Coronary artery involvement is the most recent cardiovascular manifestation to be recognized in SLE 2. seen in 2 – 16 % of patients with SLE 3. can lead to acute myocardial infarction in young women. In some cases, thrombi rather than coronary disease is responsible for the ischemia . Coronary artery vasculitis is rare. http://cardiologysearch.blogspot.in/
  13. 13. Other coronary artery manifestations - Coronary arteritis, Aneurysms, Vasospasm Embolic phenomenon http://cardiologysearch.blogspot.in/
  14. 14. Presentation Angina, Myocardial infarction, Sudden death Responsible for 0.3 % deaths. http://cardiologysearch.blogspot.in/
  15. 15. http://cardiologysearch.blogspot.in/
  16. 16. Pathogenesis http://cardiologysearch.blogspot.in/
  17. 17. Risk Factorshttp://cardiologysearch.blogspot.in/
  18. 18.  Most striking feature of CAD in SLE is the  predilection for young premenopausal women. Manzi and colleagues  lupus women aged 35 to 44 years were over 50 times more likely to have an MI as compared to controls. http://cardiologysearch.blogspot.in/
  19. 19.  modifiable risk factor for occlusive vascular disease in both general and lupus populations. Elevated homocysteine levels have been reported in 15% of lupus patients Associated with  cardiovascular events  subclinical atherosclerosis http://cardiologysearch.blogspot.in/
  20. 20. http://cardiologysearch.blogspot.in/
  21. 21.  43 yr old female A known case of SLE ANA positive On steroids http://cardiologysearch.blogspot.in/
  22. 22.  OBESITY SYSTEMIC HYPERTENSION ANEMIA Acid peptic disease Hypothyroidism Nephropathy Hemorrhoids http://cardiologysearch.blogspot.in/
  23. 23.  Old IWMI CAG-2003  Mild CAD  Mild LAD and RCA disease http://cardiologysearch.blogspot.in/
  24. 24.  Acute coronary syndrome AWMI – delayed presentation Not Thrombolised Patient managed and stabilized Taken for CAG http://cardiologysearch.blogspot.in/
  25. 25.  Right dominant system Two vessel disease Significant proximal LAD disease Critical mid RCA disease Major diagonal disease http://cardiologysearch.blogspot.in/
  26. 26.  Hypokinetic IVS, apical segments. Anterolateral segments Mild LV dysfunction EF -65 % Grade I – diastolic dysfunction http://cardiologysearch.blogspot.in/
  27. 27.  Advised CABG SURGERY with grafts to  Distal LAD  Major diagonal  Distal RCA OR PCI to LAD and RCA - IF considered high risk for CABG http://cardiologysearch.blogspot.in/
  28. 28.  Discussed with CT surgeons and anesthetists Due to Presence of  high risk profile  Symptomatic status – class III symptoms  Nephropathy – high creatinine values, cr -2.7 mg%  Patient taken for PCI http://cardiologysearch.blogspot.in/
  29. 29.  Drug eluting stent placed in  LAD -SUPRALIMUS CORE STENT  RCA - ENDEAVOR STENT Patient was started on antiplatelets http://cardiologysearch.blogspot.in/
  30. 30. http://cardiologysearch.blogspot.in/
  31. 31. http://cardiologysearch.blogspot.in/
  32. 32.  Patient developed GI –bleeding Coffee ground vomitting Profound hypotension Patient became unconscious http://cardiologysearch.blogspot.in/
  33. 33.  Blood transfusion Fluid replacement Inotrops – dopamine. Adrenaline infusion started Patient ABG - desaturation http://cardiologysearch.blogspot.in/
  34. 34.  Patient connected to mechanical ventilator Antiplatelets stopped- inspite of DES Continuous Pantoprazole infusion started http://cardiologysearch.blogspot.in/
  35. 35.  Active bleeding stopped - after 3 days Hemodynamic stability attained CLOPIDOGREL antiplatelet- started after 3 days Aspirin also restarted by 5 days http://cardiologysearch.blogspot.in/
  36. 36.  Patient improved in 5 days Shifted to ward and discharged http://cardiologysearch.blogspot.in/
  37. 37.  Blood disorder  NSAIDS – used for different symptoms in SLE ▪ Increase bleeding  Corticosteroids – produce peptic ulcer  Thrombocytopenia – increase bleeding ▪ Autoimmune ▪ Drug induced  Antiphospholipid antibody – increase thrombosis ▪ Increase chance of stent thrombosis http://cardiologysearch.blogspot.in/
  38. 38. Bleeding Stent thrombosis Anti platelets http://cardiologysearch.blogspot.in/
  39. 39. http://cardiologysearch.blogspot.in/
  40. 40.  Kindly send your suggestions to improve this site Visit us regularly for updates Send your articles/ ppt/pdf to publish in this site . http://cardiologysearch.blogspot.in/

×