Cardiac manifestations

Pericarditis induced by SLE is common and is the most frequent cardiovascular complication. Clinical diagnosis is made in 20 to 30 per cent of patients, with pericardial involvement present in over 60 per cent patients at autopsy. Pericardial involvement may be asymptomatic or manifested by precordial chest pain and a pericardial friction rub. Hemodynamic alterations are uncommon. Pericardiocentesis may be required in the presence of imminent or documented tamponade, and the fluid exhibits characteristics similar to those of pleural fluid.

Other cardiac complications include atypical (non-bacterial) verrucous (Libman-Sacks) endocarditis, myocarditis, and coronary artery disease. The basic histological lesion is the diffuse microvasculitis that leads to the characteristic fibrinoid changes in the connective tissues of the cardiovascular system. Even though the prevalence of cardiac manifestations is reported to be 50 to 60 per cent, clinical manifestations occur only when there is severe involvement.

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