Cardiac involvement in systemic lupus erythematosus not only limited to pericarditis

Editor–We read with great interest the article by Perry and colleagues (Clin Med June 2011 pp 268–70) on acute systemic lupus erythematosus (SLE) presenting as pericarditis.

The incidence of cardiac involvement in SLE at post-mortem is approximately 40%, but only 6% of patients had echocardiographic evidence of impairment, and only one death in a cohort of over 500 patients was attributable to cardiac involvement.¹

The key first step in investigation of SLE-related cardiac disease is the electrocardiogram for analysis of arrhythmias, ischaemic change, and left ventricular function. There are a number of possible cardiac manifestations of SLE, the most common forms being pericarditis, myocarditis, nonbacterial verrucous endocarditis, coronary artery disease, coronary arteritis, premature coronary atherosclerosis, congestive heart failure, cardiac arrhythmias, pulmonary hypertension and conduction disturbances.²

While there is no particular consensus on what imaging is required when cardiac involvement with SLE is suspected, the most reasonable second step is transthoracic echocardiography as with many cardiac diseases. Echocardiography can help diagnose SLE-related pericarditis, pericardial effusion, systolic dysfunction, valvular involvement, and cavity thrombus formation with a good sensitivity.³ The amount of information which is gained from an echocardiogram is especially valuable in such patient cohort. We generally suggest doing an echocardiogram on patients presenting with pericarditis to rule out the above. It can also be organised as an outpatient test if early discharge is contemplated.