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Cardiac tamponade in systemic lupus erythematosus. Report of four cases
M B Castier1, E M Albuquerque, M E Menezes
1Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Insights
Cardiac tamponade is a rare but serious complication of systemic lupus erythematosus. Prompt treatment with pericardiocentesis and corticosteroids leads to a favorable outcome in these patients.
Area of Science:
- Rheumatology
- Cardiology
- Internal Medicine
Background:
- Systemic lupus erythematosus (SLE) can present with diverse cardiac manifestations.
- Cardiac tamponade, a potentially life-threatening condition, requires careful evaluation in SLE patients.
Observation:
- Pericardial effusions were found in 33.2% of SLE patients, with 54% occurring during active disease phases.
- Cardiac tamponade was diagnosed in only 1.23% of SLE patients via clinical assessment and echocardiography.
- Affected patients were predominantly female, white, and aged 25-44, with hemorrhagic effusions positive for antinuclear antibodies (FAN) and LE cells.
Findings:
- Pericardiocentesis combined with high-dose corticosteroids proved effective in treating cardiac tamponade.
- No recurrence of pericardial effusion or progression to constrictive pericarditis was observed during a 3-year follow-up.
Implications:
- Cardiac tamponade in SLE, though infrequent, demonstrates a benign clinical course with appropriate management.
- Early diagnosis and intervention are crucial for favorable outcomes in SLE-associated cardiac tamponade.
Objective:
To report and assess the incidence of cardiac tamponade in systemic lupus erythematosus as a cardiac manifestation of the disease.
Methods:
We reviewed the medical records of 325 patients diagnosed with systemic lupus erythematosus according to the American Rheumatism Association and their complementary laboratory tests compatible with cardiac tamponade.
Results:
In the 325 medical records reviewed, we found 108 patients with pericardial effusions corresponding to 33.2% of the total and 54% of the patients studied in the active phase of the disease. Clinical assessment and transthoracic echocardiogram allowed the clinical diagnosis of cardiac tamponade in only 4 (1.23%) patients, 3 of whom were females, white, with ages ranging from 25 to 44 years. The pericardial fluid was hemorrhagic or serosanguineous with high levels of FAN and positivity for LE cells. In the treatment, we successfully used pericardiocentesis associated with high doses of corticosteroids. In clinical and laboratory follow-up performed for a period of 3 years, neither recrudescence of the pericardial effusion nor evolution to constriction occurred.
Conclusion:
Even though rare (1.23%), cardiac tamponade in patients with systemic lupus erythematosus has a benign evolution when properly treated, according to our experience.