Connective tissue disease as a challenge in heart failure: Three case reports
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Published on: June 14, 2016
Ke Liu1, Xuejiao Li1, Dan Li2
1Emergency Department of the Second Affiliated Hospital of ChongQing Medical University, Chongqing 400010, China.
Insights
Connective tissue disease (CTD) can lead to heart failure (HF), a serious complication. Early recognition and treatment of HF in CTD patients improve outcomes and quality of life.
Area of Science:
- Rheumatology
- Cardiology
- Internal Medicine
Background:
- Connective tissue diseases (CTD) are chronic, systemic autoimmune disorders characterized by immune dysregulation.
- CTD frequently impacts cardiac structures via diverse pathophysiological pathways, often leading to subclinical cardiac injury.
- Heart failure (HF) is a recognized and significant complication in patients with CTD.
Observation:
- Patients with CTD exhibit an elevated risk for cardiovascular disease, presenting with symptoms like chest pain and dyspnea.
- HF in CTD is characterized by impaired cardiac function, leading to symptoms such as shortness of breath and reduced exercise tolerance.
- CTD can precipitate HF through mechanisms including diffuse myocardial damage, valvular pathology, and coronary ischemia.
Findings:
- Treatment interventions, such as prednisone, warfarin, and immunoglobulin therapy, were administered to patients with specific CTD subtypes.
- Symptomatic relief, including improvement in chest pain and shortness of breath, was observed in CTD patients following treatment.
Implications:
- Heart failure in CTD patients carries a poor prognosis and can lead to severe deterioration.
- Prompt identification of HF symptoms (chest pain, shortness of breath) in CTD is crucial for timely intervention.
- Effective management of HF in CTD can delay disease progression, enhance prognosis, and improve patient quality of life.
Rationale:
Connective tissue disease (CTD) is a heterogeneous group of chronic inflammatory autoimmune disorders derived from a systemically auto-immunological deregulation. CTD may affect cardiac structures through multiple pathophysiological mechanisms, and subclinical cardiac injury is common. Heart failure (HF) is one of the common complications in these patients.
Patient Concerns:
Patients with CTD suffer an increased risk of cardiovascular disease and may have chest pain and shortness of breath.
Diagnosis:
HF is characterized by dyspnea or exertional limitation due to impaired ventricular filling and/or blood ejection. HF can be caused by other systemic diseases, not only by cardiovascular disorders but CTD. CTD may cause HF due to diffuse myocardial damage, heart valve damage, coronary ischemia, and so on.
Interventions:
The patient with catastrophic antiphospholipid syndrome take prednisone and warfarin. The patient with anti-synthetase syndrome was treated with immunoglobulin, followed by long-term oral medicines of prednisone, methotrexate, and folic acid.
Outcomes:
The symptoms of chest pain and shortness of breath for patients with CTD improved.
Lessons:
HF is one of the common complications in these patients with CTD, which has poor prognosis and severe aggravation. Once such patients experience chest pain, chest tightness, shortness of breath, etc, we should consider the possibility of HF. Early identification and correct treatment can delay the progression of HF, improve the prognosis, and enhance the quality of life for patients. Therefore, we should pay more attention to patients with CTD combined with HF.
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