Libman-Sacks Endocarditis Presenting as Acute Coronary Syndrome, Acute Heart Failure and Multiple Embolic Strokes

Area of Science:

• Cardiology
• Rheumatology
• Internal Medicine

Background:

• Libman-Sacks endocarditis (LSE) is a rare cardiovascular complication of systemic lupus erythematosus (SLE).
• LSE involves sterile vegetations on heart valves, potentially leading to significant cardiac dysfunction and embolic events.

Observation:

• A young African American female presented with pleuritic chest pain and was initially diagnosed with acute coronary syndrome.
• Further evaluation revealed severe mitral regurgitation, leading to a diagnosis of Libman-Sacks endocarditis via transesophageal echocardiogram.
• The patient experienced acute diastolic heart failure and multiple embolic strokes in the anterior cerebral artery/middle cerebral artery territories.

Findings:

• The case highlights the diagnostic challenges and severe sequelae of LSE in SLE patients.
• Effective management involved anticoagulation, antiplatelet therapy, and immunosuppressive agents for underlying lupus.
• Prompt diagnosis and intervention are critical to mitigate thromboembolic complications.

Implications:

• This case underscores the importance of maintaining a high index of suspicion for LSE in lupus patients presenting with cardiovascular symptoms.
• Early detection and management of LSE can prevent or reduce the severity of thromboembolic events and cardiac damage.
• Integrated care between rheumatology and cardiology is essential for optimal patient outcomes.