Autoimmune diseases and the Heart

Posted by e-Medical PPT Sunday, April 22, 2012
Overview
Vasculitis
 Takayasu arteritis
 Giant Cell arteritis
 Kawasaki disease
Vasculitis of Small or Medium-Sized Vessels
 Churg-Strauss Syndrome
Systemic Rheumatological Disorders
 Rheumatoid Arthritis
 HLA-B27–Associated Spondyloarthropathies
 Systemic Lupus Erythematosus
 Antiphospholipid Antibody Syndrome
 Scleroderma
 Sarcoidosis

Presenting Cardiac Symptoms of Autoimmune Disease
 Pericarditis
 Myocarditis or myocardial fibrosis due to myositis or
vasculitis with rhythm and conduction disturbances and
diastolic or systolic heart failure
 Ischemic heart disease (coronary arteritis)
 Endocardial involvement with valvular disease and
formation of thrombi
 Pulmonary hypertension secondary to concomitant lung
disease or recurrent lung embolism
 Unexplained arterial thrombosis
 Syncope
 Arterial hypertension (Malignant)

Prevalence of Cardiac involvement in Autoimmune Disease
 Variable
 In general, clinical symptoms are uncommon
 Initial autopsy studies suggested high incidence
of cardiac involvement
 Transesophageal echocardiogram and MRI
done routinely show prevalence approaching
that of autopsy
 Cardiac findings are uncommon at initial
diagnosis but do increase in frequency over
followup time

Takayasu Arteritis “The pulseless disease”

 Stenosis 3-4x more common than aneurysms
 Upper (and lower) extremity claudication
 Asymmetric pulses
 Aortic valve regurgitation due to aortic root
aneurysms
 Hypertension associated with renal artery
stenosis
 Coronary vasculitis in <5% of cases
 Mortality estimates of 3-35% in 5 years....


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