This information is from Lupus Foundation of America‘s website and is about how lupus can affect your cardipulmonary systems. This is essential reading for those with lupus as it can present itself at any given time. As always, talk to your own doctor about your disease and problems associated with it.
The heart and lungs are frequently affected in people with systemic lupus erythematosus (SLE). Complications in these organs can cause a variety of problems, ranging from mild to serious or even life-threatening. These complications are known as cardiopulmonary (cardio = heart; pulmonary = lung).
It is very important to know the differences between cardiopulmonary complications and non-lupus related problems. The medical examination and laboratory and other tests will help to determine the cause of the problem so appropriate therapy can be used.
Types of Heart or Lung Involvement in Lupus
When investigating a person with cardiopulmonary symptoms, a number of possible causes must be considered. Some problems that can occur in SLE are:
Other possible cardiopulmonary problems
Heart and lung problems that are not necessarily lupus-related include:
Cardiac (Heart) Involvement
Lupus can involve all parts of the heart:
Pericarditis, or inflammation of the sac around the heart, is the most common heart involvement in people with lupus. This condition occurs when antigen-antibody complexes-also known as immune complexes-are made during active lupus and cause inflammation within the pericardium.
Symptoms of pericarditis
Pericarditis can occur in conditions other than lupus, therefore the cause must be determined before treatment begins. To help diagnose pericarditis, these tests may be ordered:
When lupus causes inflammation of the tissue of the heart, myocarditis occurs. However, serious heart muscle disease is not common in SLE.
Symptoms of myocarditis
Myocarditis is often seen with inflammation of other muscles in the body, and this condition can lead to tissue damage that replaces heart tissue with scar tissue.
Treatment usually includes corticosteroids such as prednisone. Immunosuppressive drugs such as Cytoxan (cyclophosphamide) and Imuran (azathioprine) may be added if the inflammation is not completely controlled with corticosteroids.
When lupus causes inflammation of the lining of the inside of the heart, endocarditis occurs.
Symptoms of endocarditis
Coronary artery disease
The coronary arteries deliver blood and oxygen to the heart muscle and are vital to the heart’s pumping function. In people with lupus, these arteries can become prematurely narrowed, causing coronary artery disease.
Studies suggest that people with lupus are more likely to develop premature atherosclerosis if they are on corticosteroids (prednisone) or have kidney involvement.
This blockage can be due to:
Symptoms of coronary artery disease
In addition, heart damage can develop from inflammation in active lupus or from medications.
Diagnosing coronary artery disease
Early and accurate diagnosis, combined with aggressive therapy to reduce organ damage, is crucial in order to minimize permanent heart damage. Typical tests include:
Treating coronary artery disease
Treatment of cardiac problems must be individualized for each person and for each problem. However, prevention is the primary treatment of coronary artery disease.
These are three important factors in preventing heart attacks in people with lupus:
Pulmonary (Lung) Involvement
The wide range of pulmonary manifestations (symptoms) associated with lupus needs prompt evaluation and close monitoring.
Diagnostic tools can include:
While lupus can affect the lungs in many ways, pleuritis (pleurisy) is the most common pulmonary manifestation.
The pleura is a membrane that covers the outside of the lung and the inside of the chest cavity. It produces a small amount of fluid to lubricate the space between the lung and the chest wall. As lupus activity generates immune complexes, they initiate an inflammatory response at this membrane, a condition called pleuritis.
Symptoms of pleuritis
Sometimes an excessive amount of fluid builds up in the pleural space between the lung and the chest wall. This is called a pleural effusion and occurs less often then pleuritis.
Diagnosing pleural effusion
If the effusion is large enough, it can be seen on a chest x-ray. Since infection or conditions other than lupus can cause pleural effusions, the physician may need to take a sample of the fluid and perform tests to help determine its cause.
Treating pleural effusion
Pleural effusions will usually respond to these medications:
Pleural effusions also may clear by themselves with time.
Pneumonitis is inflammation within the lung tissue. Infection is the most common cause of pneumonitis in people with lupus. Bacteria, virus, or fungi are organisms that can cause infection in the lung. Sometimes pneumonitis may occur without infection and is then called non-infectious pneumonitis.
Symptoms of pneumonitis
Since both forms of pneumonitis have the same symptoms, the patient is assumed to have an infection until proven otherwise. The diagnosis of pneumonitis requires:
To determine if infection is the cause of the pneumonitis the physician may also need to perform:
Treatment initially includes a course of antibiotics. If laboratory and other diagnostic tests show no proof of infection, then the diagnosis is likely lupus pneumonitis.
This non-infectious pneumonitis is treated with high doses of corticosteroids. Immunosuppressive drugs such as Imuran (azathioprine) may be added if the inflammation is not controlled with corticosteroids.
Chronic diffuse interstitial lung disease
Chronic diffuse (widespread) interstitial lung disease is relatively uncommon in people with SLE. Chronic interstitial lung disease scars the lung. This scarred tissue acts as a barrier to the oxygen that normally moves easily from the lung into the blood.
Besides lupus, there are other reasons for this condition. Correct identification of the cause is necessary in order to chose the proper treatment.
Symptoms of chronic diffuse interstitial lung disease
Diagnosing chronic diffuse interstitial lung disease
To determine the cause, special procedures are required, such as:
Treating chronic diffuse interstitial lung disease
Chronic lupus interstitial lung disease is primarily treated with corticosteroids, with varying results. In general, the lung function can be stabilized with treatment.
The progression of chronic interstitial lung disease can be measured with several tests that assess disease activity and the person’s response to therapy. These include: