Lupus is an autoimmune disease that can affect many parts of the body, including the heart. Lupus causes inflammation which can damage tissue and organs. When lupus affects the heart, it is called lupus cardiomyopathy. Some of the signs and symptoms of lupus cardiomyopathy include:
- Chest pain
- Shortness of breath
- Fatigue
- Irregular heartbeat
- Buildup of fluid in the lungs or legs
If you experience any of these heart-related symptoms along with other common lupus symptoms like joint pain, rash, and fever, it may indicate lupus is affecting your heart. However, these signs can also be caused by many other heart conditions not related to lupus. So how do you know for sure if you have lupus cardiomyopathy?
Diagnostic Tests
There are several tests doctors use to diagnose lupus cardiomyopathy:
Echocardiogram
An echocardiogram uses ultrasound waves to create images of the heart’s structure and function. It can detect problems with the heart valves or pumping function that may be caused by lupus inflammation.
Electrocardiogram
An EKG records the heart’s electrical activity. It may show irregular heart rhythms or other abnormal patterns in patients with lupus cardiomyopathy.
Blood tests
Blood tests look for biomarkers that indicate heart muscle damage. Levels of troponin and BNP may be elevated in lupus affecting the heart.
Cardiac MRI
A cardiac MRI uses magnets and radio waves to get 3D images of the heart. It can identify areas of inflammation or scarring caused by lupus.
Cardiac catheterization
In this procedure, a thin flexible tube is inserted into a blood vessel leading to the heart. It allows doctors to see blockages in the coronary arteries that may be related to lupus.
Monitoring Lupus Heart Involvement
If you’ve been diagnosed with lupus, regular cardiac screening can help detect heart problems early. Your doctor may recommend:
- Electrocardiograms every 1-2 years
- Annual echocardiograms if heart abnormalities are found
- Blood tests for cardiac enzyme levels
- Holter or event monitoring if rhythm disturbances are suspected
Let your doctor know if you develop any new heart-related symptoms like prolonged chest pain, palpitations, dizziness or swelling. Call 911 if you have sudden severe chest pain or difficulty breathing which could indicate a heart attack.
Risk Factors
Certain lupus patients are at increased risk of developing cardiomyopathy. Risk factors include:
- Having antiphospholipid antibodies – these may cause blood clots in heart vessels
- Longer lupus duration
- More severe lupus activity
- Prior kidney disease from lupus (lupus nephritis)
- Use of immunosuppressant drugs like cyclophosphamide
- Positive anti-Ro/SSA antibodies
- Overlap with another autoimmune disease like rheumatoid arthritis
African American patients are more likely to develop heart complications from lupus for reasons that are not entirely clear. Having more risk factors increases the chance of cardiomyopathy.
Lifestyle Changes
Making heart-healthy lifestyle changes can help manage lupus affecting your heart. Recommendations include:
- Following an anti-inflammatory diet – emphasize fruits, vegetables, whole grains, fish, nuts
- Exercising regularly as tolerated – light cardio and strength training can improve heart health
- Quitting smoking to reduce heart disease risk
- Limiting alcohol intake
- Managing stress – try meditation, yoga, tai chi
- Getting enough rest and sleep
Keep your blood pressure and cholesterol at healthy levels through diet, exercise, and medication if prescribed. Lose excess weight if you are overweight. All of these steps will take strain off your heart.
Medical Treatments
If lifestyle measures are not enough, your doctor may prescribe medications to treat lupus cardiomyopathy:
Corticosteroids
Steroids like prednisone reduce inflammation and may improve heart function in active lupus. High doses may be given intravenously in severe flares.
Immunosuppressants
Drugs like methotrexate, azathioprine, mycophenolate mofetil and cyclosporine suppress the overactive immune system in lupus. This helps reduce inflammation and prevent further heart damage.
Hydroxychloroquine
Hydroxychloroquine is commonly used to treat lupus symptoms. It may also benefit the heart by lowering cholesterol and blood pressure.
Biologics
Newer biologic drugs like belimumab (Benlysta) target specific parts of the immune system. They are sometimes used for heart and other organ involvement.
Anticoagulants
If blood clots are causing heart problems, anticoagulants like warfarin or heparin can prevent clot formation and improve blood flow.
Diuretics
Water pills help reduce fluid buildup in the lungs and legs from heart failure. Furosemide, spironolactone and other diuretics relieve swelling and breathing difficulties.
ACE inhibitors
Angiotensin converting enzyme (ACE) inhibitors widen blood vessels, lowering blood pressure and strain on the heart. They help treat hypertension and heart failure.
Beta blockers
Beta blockers like metoprolol slow the heart rate and lower blood pressure. They can improve irregular heart rhythms and chest pain caused by lupus.
Digoxin
Digoxin strengthens the heart’s pumping ability and is used for heart failure. It also controls irregular heart rhythms associated with lupus cardiomyopathy.
| Treatment | Medical Uses |
|---|---|
| Corticosteroids | Reduce inflammation |
| Immunosuppressants | Suppress overactive immune system |
| Hydroxychloroquine | Lower cholesterol and blood pressure |
| Biologics | Target specific parts of immune system |
| Anticoagulants | Prevent blood clot formation |
| Diuretics | Reduce fluid buildup in lungs and legs |
| ACE inhibitors | Lower blood pressure |
| Beta blockers | Slow heart rate, lower blood pressure |
| Digoxin | Strengthen heart pumping ability |
Surgery
In severe cases where the heart is badly damaged, surgery may be needed. Procedures include:
- Coronary artery bypass – improves blood supply to the heart muscle
- Heart valve repair or replacement – fixes leaky or narrow heart valves
- Implantable cardioverter defibrillator (ICD) – provides shocks to stabilize abnormal heart rhythms and prevent sudden cardiac arrest
- Pacemaker – helps coordinate heartbeats if the heart’s natural pacemaker isn’t working properly
- Heart transplant – reserved for end-stage heart failure when all other treatments have failed
Prognosis
The outlook for lupus patients with cardiomyopathy can vary greatly depending on the severity of heart involvement:
- Mild cases may cause few symptoms and resolve with treatment of active lupus
- Moderate cardiomyopathy often responds well to medications but requires close monitoring
- Severe heart disease can lead to heart failure, arrhythmias, valve problems or the need for implanted devices or transplant
Early detection and treatment are key to preventing permanent damage. With proper management, many patients with lupus cardiomyopathy are able to control symptoms and maintain a good quality of life. Close follow up care with both a rheumatologist and cardiologist is recommended.
Conclusion
Lupus can sometimes affect the heart, causing inflammation and damage known as lupus cardiomyopathy. Symptoms may include chest pain, shortness of breath, irregular heartbeat and swelling. Tests like EKGs, cardiac MRI and blood tests help diagnose the condition. Those at highest risk include African Americans and those with other risk factors like kidney disease. Lifestyle changes, medications, devices and surgery may be used to treat lupus heart problems. With proper treatment, many patients are able to manage this complication well. Being aware of potential heart effects is important for anyone with lupus. Reporting new cardiac symptoms promptly allows early intervention to improve outcomes.
