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SLE and cardiovascular manifestations

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    SLE  and cardiovascular manifestations SLE and cardiovascular manifestations Presentation Transcript

    • http://cardiologysearch.blogspot.in/http://cardiologysearch.blogspot.in/ http://cardiologysearch.blogspot.in/
    •  Cardiac disease is common among patients with systemic lupus erythematosus (SLE) as  pericardial,  myocardial,  valvular and  coronary artery involvement http://cardiologysearch.blogspot.in/
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    •  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/
    •  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/
    •  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/
    •  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/
    •  MYOCARDITIS  uncommon,  asymptomatic manifestation of SLE  prevalence of 8 to 25 % in different studies http://cardiologysearch.blogspot.in/
    •  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/
    • 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/
    • Other coronary artery manifestations - Coronary arteritis, Aneurysms, Vasospasm Embolic phenomenon http://cardiologysearch.blogspot.in/
    • Presentation Angina, Myocardial infarction, Sudden death Responsible for 0.3 % deaths. http://cardiologysearch.blogspot.in/
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    • Pathogenesis http://cardiologysearch.blogspot.in/
    • Risk Factorshttp://cardiologysearch.blogspot.in/
    •  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/
    •  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/
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    •  43 yr old female A known case of SLE ANA positive On steroids http://cardiologysearch.blogspot.in/
    •  OBESITY SYSTEMIC HYPERTENSION ANEMIA Acid peptic disease Hypothyroidism Nephropathy Hemorrhoids http://cardiologysearch.blogspot.in/
    •  Old IWMI CAG-2003  Mild CAD  Mild LAD and RCA disease http://cardiologysearch.blogspot.in/
    •  Acute coronary syndrome AWMI – delayed presentation Not Thrombolised Patient managed and stabilized Taken for CAG http://cardiologysearch.blogspot.in/
    •  Right dominant system Two vessel disease Significant proximal LAD disease Critical mid RCA disease Major diagonal disease http://cardiologysearch.blogspot.in/
    •  Hypokinetic IVS, apical segments. Anterolateral segments Mild LV dysfunction EF -65 % Grade I – diastolic dysfunction http://cardiologysearch.blogspot.in/
    •  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/
    •  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/
    •  Drug eluting stent placed in  LAD -SUPRALIMUS CORE STENT  RCA - ENDEAVOR STENT Patient was started on antiplatelets http://cardiologysearch.blogspot.in/
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    •  Patient developed GI –bleeding Coffee ground vomitting Profound hypotension Patient became unconscious http://cardiologysearch.blogspot.in/
    •  Blood transfusion Fluid replacement Inotrops – dopamine. Adrenaline infusion started Patient ABG - desaturation http://cardiologysearch.blogspot.in/
    •  Patient connected to mechanical ventilator Antiplatelets stopped- inspite of DES Continuous Pantoprazole infusion started http://cardiologysearch.blogspot.in/
    •  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/
    •  Patient improved in 5 days Shifted to ward and discharged http://cardiologysearch.blogspot.in/
    •  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/
    • Bleeding Stent thrombosis Anti platelets http://cardiologysearch.blogspot.in/
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    •  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/