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[Angina Pectoris in a Young Woman with Lupus Erythematosus]
Simon Braumann1, Malte P Bartram2, Roman Pfister1
1Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Köln.
Insights
Young women with lupus erythematosus (LE) experiencing chest pain may have underlying coronary artery disease. Early consideration of acute coronary syndrome is crucial, even with typical lupus symptoms like pericarditis.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Cutaneous lupus erythematosus (CLE) is an autoimmune disease with potential systemic manifestations.
- Cardiovascular complications, including coronary artery disease (CAD), are increasingly recognized in patients with lupus erythematosus (LE).
- Chest pain in LE patients can mimic or mask underlying cardiac ischemia.
Observation:
- A 31-year-old woman with a 6-year history of CLE presented with chest pain, initially diagnosed as pericarditis.
- Despite treatment for lupus and pericarditis, symptoms recurred and worsened.
- Elevated troponin and cardiac enzymes led to cardiac catheterization, revealing severe three-vessel coronary artery disease.
Findings:
- The patient underwent successful myocardial revascularization surgery.
- Postoperative recovery was uneventful despite ongoing immunosuppressive therapy for LE.
- This case highlights a severe presentation of CAD in a young woman with LE.
Implications:
- Coronary artery disease poses a significantly elevated risk in patients with lupus erythematosus.
- Acute coronary syndrome should be strongly considered in young women with LE presenting with chest pain, irrespective of concurrent cardiopulmonary lupus manifestations.
- This underscores the need for comprehensive cardiovascular risk assessment and management in LE patients.
Abstract:
History and clinical findings We present a 31-year old woman with a 6-year history of cutaneous lupus erythematosus (CLE) who presented to the emergency room with typical chest pain. ECG and transthoracic echocardiography were normal. Her working diagnosis of pericarditis was made due to systemic progression of her lupus erythematosus (LE). Treatment with NSAIDs was initiated and her immunosuppressive regimen intensified. The patient was discharged after resolution of her symptoms. A week later, the patient was seen at the rheumatology clinic with recurrence and aggravation of her symptoms. She was found to have elevated troponin and cardiac enzymes and therefore underwent cardiac catheterization, revealing three vessel coronary artery disease. Therapy and course The patient underwent urgent open surgical myocardial revascularization. Despite the immunosuppressive therapy the postoperative course was uneventful. Conclusions The risk for coronary artery disease in LE patients is very high. Particularly in young women presenting with chest pain, regardless of typical cardiopulmonary manifestations of LE such as pericarditis and pleurisy, acute coronary syndrome should always be considered.
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