Myocardial infarction, papillary muscle dysfunction and mitral valvular incompetence in systemic lupus erythaematosus

Area of Science:

• Cardiology
• Rheumatology
• Pathology

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
• Cardiac involvement in SLE can range from pericarditis to myocarditis and valvular disease.
• Myocardial infarction (MI) is an uncommon but serious complication of SLE.

Observation:

• This report details a fatal case of SLE with a history of myocardial infarction, papillary muscle dysfunction, and mitral incompetence.
• The cardiac complications occurred seven months prior to the patient's death.
• Necropsy was performed to investigate the cause of death.

Findings:

• The myocardial infarction was attributed to multiple occlusive thrombi within the epicardial branches of the coronary artery.
• Crucially, there was no evidence of underlying atherosclerosis in the coronary arteries.
• No signs of previous coronary arteritis were identified, suggesting a non-atherosclerotic, non-inflammatory etiology for the thrombi.

Implications:

• This case underscores the potential for SLE to precipitate acute coronary events through mechanisms other than traditional atherosclerosis.
• It highlights the importance of considering thrombotic events in SLE patients presenting with cardiac symptoms, even in the absence of risk factors for coronary artery disease.
• Further research into the prothrombotic mechanisms in SLE may be warranted to improve patient management and outcomes.