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Non-ST-elevation myocardial infarction hiding behind myopericarditis in a patient with systemic lupus erythematosus

Howard Freeman1, Katherine Lutz2, Patricio Riquelme2

  • 1Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA freeman.howie@gmail.com.

BMJ Case Reports
|February 26, 2022
PubMed

Insights

Systemic lupus erythematosus (SLE) patients face a high risk of heart attack. Early evaluation for cardiovascular disease is vital, even in younger patients without traditional risk factors, for timely diagnosis and treatment.

Area of Science:

  • Cardiology
  • Rheumatology
  • Immunology

Background:

  • Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with significant cardiovascular complications.
  • Cardiac manifestations in SLE commonly include pericarditis, but also a substantially increased risk of premature atherosclerosis and acute coronary syndrome (ACS).

Observation:

  • A 39-year-old male with newly diagnosed SLE presented with acute myopericarditis and pericardial tamponade.
  • Following initial presentation, the patient developed an infero-septal non-ST-elevation myocardial infarction.

Findings:

  • Percutaneous coronary intervention revealed a 100% occlusion of the proximal right coronary artery (RCA).
  • Two overlapping drug-eluting stents were successfully deployed to the proximal-mid RCA, restoring blood flow.

Implications:

  • This case highlights the critical need for comprehensive cardiovascular assessment in SLE patients, irrespective of age or traditional risk factors.
  • Prompt recognition and management of acute coronary syndrome (ACS) are essential for improving outcomes in patients with SLE.

Keywords:
ischaemic heart diseasepericardial diseasesystemic lupus erythematosus

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