Cardiac complications of polymyositis
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Journal of the Neurological Sciences
|September 1, 1980
Insights
Polymyositis can cause severe heart problems, including heart block and dilated cardiomyopathy, even with effective muscle treatment. Pacemakers may be needed to manage cardiac complications in polymyositis patients.
Area of Science:
- Cardiology
- Neurology
- Immunology
Background:
- Polymyositis is an idiopathic inflammatory myopathy characterized by symmetrical proximal skeletal muscle weakness.
- Cardiac involvement in polymyositis is recognized but often underdiagnosed.
- The impact of polymyositis on cardiac conduction and structure requires further investigation.
Observation:
- Three patients with polymyositis, confirmed by enzyme assays and muscle biopsy, presented with significant cardiac complications.
- Progressive fascicular block was observed in all patients, despite immunosuppressive therapy that adequately controlled skeletal muscle disease.
- Echocardiographic examinations revealed evidence of dilated cardiomyopathy in all three cases.
Findings:
- Despite immunosuppressive treatment for skeletal muscle inflammation, polymyositis can lead to progressive cardiac conduction abnormalities, specifically fascicular block.
- Complete heart block developed in these patients, necessitating pacemaker implantation due to syncope.
- Dilated cardiomyopathy was a consistent echocardiographic finding, suggesting widespread cardiac involvement.
Implications:
- This case series highlights the critical need for cardiac monitoring in polymyositis patients, even when skeletal muscle disease is managed.
- Early detection and management of cardiac complications in polymyositis may prevent severe outcomes like complete heart block.
- Understanding the cardiac manifestations of polymyositis is crucial for comprehensive patient care and therapeutic strategies.
Abstract:
We report 3 cases of polymyositis, confirmed by enzyme assay and muscle biopsy, complicated by serious cardiac disease. They showed progressive fascicular block, despite immunosuppressive therapy sufficient to control the skeletal muscle disease, culminating in complete heart block with syncope, requiring the implantation of a pacemaker. In addition, all 3 showed echocardiographic evidence of dilated cardiomyopathy.