2. Cardiac disease is common among patients
with systemic lupus erythematosus (SLE) as
pericardial,
myocardial,
valvular and
coronary artery involvement
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6. Pericardial involvement is the
Pericardial effusion
pericarditis
second most common echocardiographic lesion in
SLE, and
most frequent cause of symptomatic cardiac
disease.
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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
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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
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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
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10. MYOCARDITIS
uncommon,
asymptomatic manifestation of SLE
prevalence of 8 to 25 % in different studies
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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.
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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.
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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.
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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
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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
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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
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29. Drug eluting stent placed in
LAD -SUPRALIMUS CORE STENT
RCA - ENDEAVOR STENT
Patient was started on antiplatelets
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34. Patient connected to mechanical ventilator
Antiplatelets stopped- inspite of DES
Continuous Pantoprazole infusion started
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35. Active bleeding stopped - after 3 days
Hemodynamic stability attained
CLOPIDOGREL antiplatelet- started after 3
days
Aspirin also restarted by 5 days
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36. Patient improved in 5 days
Shifted to ward and discharged
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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
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38. Bleeding Stent thrombosis
Anti platelets
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