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[Spontaneous coronary dissection associated with systemic lupus erythematosus]
Manuel García-Sánchez1, Jorge Carrillo2, Yuyi Montero3
1Servicio de Cardiología Clínica, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México.
Archivos De Cardiologia De Mexico
|November 23, 2020
Summary
A young woman with systemic lupus erythematosus developed spontaneous coronary artery dissection, a rare complication. This case highlights the importance of individualized treatment for this condition in patients with lupus.
Area of Science:
- Cardiology
- Rheumatology
- Nephrology
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease.
- Lupus nephritis is a common complication of SLE, potentially leading to end-stage renal disease.
- Spontaneous Coronary Artery Dissection (SCAD) is a rare but serious condition, more prevalent in women.
Observation:
- A 29-year-old female with a 15-year history of SLE, lupus nephritis on peritoneal dialysis, and prior myopericarditis presented with worsening functional class due to dyspnea and angina.
- Echocardiogram revealed severe mitral and tricuspid regurgitation.
- Cardiac catheterization showed triple-vessel coronary artery disease with ectasia and dissection of the intermediate and circumflex branches.
Findings:
- Rheumatology ruled out active lupus disease at admission.
- The patient experienced unstable angina with adrenergic and vagal surges.
- Coronary artery bypass grafting, mitral valve replacement, and tricuspid valve repair were recommended.
Implications:
- SCAD associated with SLE is exceedingly rare (0.42% incidence).
- This case underscores the importance of considering SCAD in SLE patients presenting with acute coronary syndromes.
- Treatment for SCAD requires individualized assessment based on affected vessels and hemodynamic status.
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