Presented by Dr. Amit Patel at the spring 2017 Patient Education Conference, hosted by the Scleroderma Foundation of Greater Chicago

1. Normal Heart Function and Changes
That Can Occur in Scleroderma
Amit R. Patel MD, FACC
Associate Professor of Medicine and Radiology
Director Cardiac MRI and CT

2. Scleroderma |
Goals of Presentation
• To review the normal heart function
• To discuss heart problems that can occur in people with scleroderma
• To briefly review cardiac tests that are commonly used to evaluate heart disease
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3. Scleroderma |
Why We Need a Heart
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The best and most beautiful things in the world cannot be
seen or even touched. They must be felt with the heart.
Helen Keller
The heart of a fool is in his mouth, but
the mouth of a wise man is in his heart.
Benjamin Franklin
The less you open your heart to others, the more your
heart suffers.
Deepak Chopra
I think there is only one quality worse than
hardness of heart and that is softness of head.
Theodore Roosevelt
To wear your heart on your sleeve isn't a very good
plan; you should wear it inside, where it functions best.
Margaret Thatcher

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Why We Really Need a Heart
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Walk Enjoy the Flowers Think Climb Mountains

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How We “Power” Our Cells
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(Energy)

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A Powerful Pump
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The Heart is Actually 2 Pumps: Right and Left Ventricles
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• Heart beats 60-100 times a minute
or >30million times per year
• Pumps 4-8 liters of blood per
minute or >2million liters per year
• Heart does >25million Joules of
work per year
• Left ventricle creates systemic blood pressure
of 90-140mmHg
• Higher because blood has to get to entire body
• Right ventricle creates pulmonary artery blood
pressure of 15-30mmHg
• Lower because blood only has to pump through
air filled lungs

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The Heart has 2 “Filling” Reservoirs to Collect Blood: The Atria
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Controlling the Direction of Blood Flow: Heart Valves
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Coordinating Heart Function: The Conduction System
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Powering the Heart Muscle: Coronary Arteries and Microvasculature
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Changes that Occur with Exercise
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Heart Function While Sitting Heart Function While Running
• Heart rate increases
• Blood pressure increases
• Heart pumps “harder”
• Energy requirements go up
• Oxygen requirements go up
• Blood flow to heart muscle
increases 5-8x above normal!

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The Coronary Arteries and the Microvasculature
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Impact of Coronary Heart Disease in the United States
Coronary heart disease is
responsible for 1 of every 6
deaths in the United States.
Each year approximately 785,000
Americans will have a new
coronary attack and 470,000 will
have a recurrent attack.
Cost of cardiovascular disease
>$175 billion per year.
Approximately 900,000 stents
implanted each year.
Approximately 500,000 patients
undergo bypass surgery each
year.
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Andrus. Circ: CV Quality and Outcomes 2012

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Progression of Coronary Atherosclerosis
Pepine. AJC 1998
153

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Heart Attack
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Risk Factors for Coronary Artery Disease
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Symptoms of Coronary Artery Disease
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19. Gaemperli. EHJ 2013
Scleroderma |
When Blood Flow to Heart Muscle Can’t Be Increased
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How to Detect Coronary Artery Disease: Stress Echo
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How to Detect Coronary Artery Disease: Nuclear Stress Test
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How to Detect Coronary Artery Disease: Stress MRI
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20 gauge IV
EKG
History
Exam
Consent
Patient
placed in
scanner,
vital signs
checked
Regadenoson
0.4mg IVP
SSFP Function and Volumes
Late gadolinium
enhancement (PSIR)
15 minutes
5 minutes1 min
Regadenoson Recovery
aminophylline
1.5T (Philips Acheiva)
Hybrid GRE-EPI
3 SAX slices
0.075mmol/kg GD-
DTPA-BMA
4ml/sec

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How to Detect Coronary Artery Disease: Cardiac CT
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How to Detect Coronary Artery Disease: Heart Catheterization
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Microvascular Disease: An Important Problem in Scleroderma
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Abnormal Myocardial Perfusion Due to Microvascular Disease
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Rest
Adenosine

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Increased Stiffness of the Heart Muscle
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Eriksson. EHJ-CVI 2013

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Back Pressure Into Arteries of the Lungs: Pulmonary Hypertension
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High Pulmonary Artery Pressures Leads to Right Heart Failure
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Other Cardiac Problems in Scleroderma
• Heart rhythm problems
– Fast atrial arrhythmias
– Fast ventricular arrhythmias
– Slow heart rhythms (heart
block)
• Scarring of the pericardium
(lining of the heart)
• Heart valve problems
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Questions?