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Acute myocarditis and ventricular fibrillation as initial presentation of pediatric systemic lupus erythematosus. Rheumatol Int 2011; 33:1093-6. [DOI: 10.1007/s00296-011-2240-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
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102
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Sridhar ARM, Parasa S, Navaneethan U, Crowell MD, Olden K. Comprehensive study of cardiovascular morbidity in hospitalized inflammatory bowel disease patients. J Crohns Colitis 2011; 5:287-94. [PMID: 21683298 DOI: 10.1016/j.crohns.2011.01.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 01/26/2011] [Accepted: 01/31/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND The full extent of cardiovascular morbidity in inflammatory bowel disease is not well understood. OBJECTIVE To comprehensively study the association of different cardiovascular diseases in hospitalized patients with inflammatory bowel disease (IBD) using a large database. METHODS We used the Nationwide Inpatient Sample (NIS) database to perform a cross-sectional study. The study group was defined as all hospitalized patients between ages 18-60 years included in the NIS 2006 database with a discharge diagnosis of IBD, as per the International Classification of Diseases - Clinical Modification, 9th revision (ICD-9-CM) codes. Individuals in the same age group whose hospital discharge records did not note IBD were identified as the control group. Cardiovascular diseases, identified by the ICD-9-CM codes, were studied comprehensively for their association with IBD using multivariate logistic regression analysis. Odds ratios were calculated adjusting for relevant patient comorbidities. RESULTS IBD was found to be strongly associated with mesenteric ischemia (adjusted odds ratio (aOR), 3.4; 95% confidence interval (CI), 2.9-4.0) and venous thrombotic diseases (aOR, 1.38; 95% CI, 1.25-1.53). Age and gender stratified analysis revealed that IBD is positively associated with dysrhythmias in females aged 18-39 years (aOR, 2.05; 95% CI, 1.72-2.44). We did not find an increased risk of other cardiovascular diseases in IBD patients. CONCLUSIONS Our study substantiates the previously reported associations of mesenteric ischemia and venous thrombotic disorders with IBD. Our study also suggests that young females with IBD might have an increased risk for dysrhythmias.
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Cardiac Sarcoidosis and Giant Cell Myocarditis as Causes of Atrioventricular Block in Young and Middle-Aged Adults. Circ Arrhythm Electrophysiol 2011; 4:303-9. [DOI: 10.1161/circep.110.959254] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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104
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Prado DMLD, Gualano B, Miossi R, Sá-Pinto AL, Lima FR, Roschel H, Borba EF, Bonfá E. Abnormal chronotropic reserve and heart rate recovery in patients with SLE: a case–control study. Lupus 2011; 20:717-20. [DOI: 10.1177/0961203310397081] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- DM Leite do Prado
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
| | - B Gualano
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
- School of Physical Education and Sport, University of São Paulo, Brazil
| | - R Miossi
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
| | - AL Sá-Pinto
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
| | - FR Lima
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
| | - H Roschel
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
- School of Physical Education and Sport, University of São Paulo, Brazil
| | - EF Borba
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
| | - E Bonfá
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
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Yamamura K, Ohga S, Nishiyama K, Doi T, Tsutsumi Y, Ikeda K, Fujishima A, Takada H, Hara T. Recurrent atrial fibrillation after high-dose methylprednisolone therapy in a girl with lupus-associated hemophagocytic syndrome. Lupus 2011; 20:871-5. [DOI: 10.1177/0961203310392429] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemophagocytic syndrome (HPS) is a serious complication of systemic lupus erythematosus (SLE). A 15-year-old female with lupus-nephritis developed HPS. Bone marrow study showed florid thrombophagocytosis. There was no associated infection. High-dose methylprednisolone therapy ameliorated HPS. However, atrial fibrillation (Af) repeated after the infusion and required direct-current cardioversion. No underlying diseases were found in the heart and endocrine system. Chest roentgenogram and echocardiography were normal. Electrocardiogram showed slightly prolonged PR interval in sinus rhythm. Af occurred at high circulating levels of interferon-γ and interleukin (IL)-10, but not IL-6, IL-2, tumor necrosis factor-α, C-reactive protein or catecholamines. This is the first observation that high-dose corticosteroid induced Af in a case of lupus-HPS. Af is unusual in SLE children without cardiac disease, while conduction defect occurs associated with lupus-myocarditis. Lupus-HPS may be an aggressive SLE subset with cardiac involvement. High-dose corticosteroid infusion controls lupus activity, but could disclose the cardiac stress in lupus-HPS patients.
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Affiliation(s)
- K Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - S Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - K Nishiyama
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Doi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y Tsutsumi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - K Ikeda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - A Fujishima
- Division of Clinical Laboratories, Kyushu University Hospital, Fukuoka, Japan
| | - H Takada
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Hara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Ashrafi R, Garg P, McKay E, Gosney J, Chuah S, Davis G. Aggressive cardiac involvement in systemic lupus erythematosus: a case report and a comprehensive literature review. Cardiol Res Pract 2011; 2011:578390. [PMID: 21350606 PMCID: PMC3042616 DOI: 10.4061/2011/578390] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 12/24/2010] [Accepted: 01/07/2011] [Indexed: 11/20/2022] Open
Abstract
Background. We present the case of a 35-year-old gentleman who presented with an aggressive cardiomyopathy with normal coronary arteries. He was later diagnosed with systemic lupus-related cardiomyopathy. Methods. We undertook an extensive review of the literature regarding cardiac manifestations of lupus and used over 100 journals to identify the key points in pathology, diagnosis, and treatment. Results. We have shown that cardiac lupus can be rapidly progressive and, unless treated early, can have severe consequences. The predominant pathologies are immune complex and accelerated atherosclerosis drive. Treatment comprised of high-level immunosuppression.
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Affiliation(s)
- Reza Ashrafi
- Aintree Cardiac Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK
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107
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Reversible complete heart block in ANCA-associated vasculitis. Clin Res Cardiol 2010; 100:93-5. [DOI: 10.1007/s00392-010-0234-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
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108
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Unuma K, Harada K, Nakajima M, Ito T, Okutsu K, Yoshida KI. Unexpected death of a patient with rheumatoid arthritis complicated by a cervical deformity. Leg Med (Tokyo) 2010; 12:242-5. [DOI: 10.1016/j.legalmed.2010.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 05/21/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
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Dogdu O, Yarlioglues M, Kaya MG, Ardic I, Oguzhan N, Akpek M, Sahin O, Akyol L, Kelesoglu S, Koc F, Ozdogru I, Oguzhan A. Deterioration of heart rate recovery index in patients with systemic lupus erythematosus. J Rheumatol 2010; 37:2511-5. [PMID: 20810503 DOI: 10.3899/jrheum.100163] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disorder resulting in multisystemic inflammatory damage. It is reported that cardiovascular diseases (CVD) are responsible for 20%-30% of deaths in patients with SLE. Heart rate recovery after exercise is a function of vagal reactivation, and its impairment is an independent prognostic indicator for cardiovascular and all-cause mortality. The aim of our study was to evaluate the heart rate recovery index in patients with SLE. METHODS The study population included 48 patients with SLE (35 women, mean age 46.3 ± 12.8 yrs, mean disease duration 6.0 ± 2.3 yrs) and 44 healthy controls (30 women, mean age 45.7 ± 12.9 yrs). Basal electrocardiography, echocardiography, and treadmill exercise testing were performed on all patients and controls. The heart rate recovery index was defined as the reduction in the heart rate from the rate at peak exercise to the rate at the first minute (HRR(1)), second minute (HRR(2)), third minute (HRR(3)), and fifth minute (HRR(5)) after stopping exercise stress testing. RESULTS There were significant differences in HRR(1) and HRR(2) indices between patients with SLE and the control group (24.1 ± 6.5 vs 33.3 ± 9.3; p < 0.001, and 44.6 ± 13.3 vs 53.7 ± 9.9; p < 0.001, respectively). Similarly, HRR(3) and HRR(5) indices of the recovery period were lower in patients with SLE, compared with indices in the control group (57.6 ± 13.0 vs 64.9 ± 11.7; p = 0.006, and 67.2 ± 12.3 vs 75.0 ± 15.4; p = 0.009, respectively). Effort capacity was markedly lower (9.0 ± 1.9 vs 11.1 ± 2.3 metabolic equivalents; p = 0.001, respectively) among the patients with SLE. CONCLUSION The heart rate recovery index is deteriorated in patients with SLE. When the prognostic significance of the heart rate recovery index is considered, these results may contribute to explain the increased occurrence of cardiac death. It points to the importance of the heart rate recovery index in the identification of high-risk patients.
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Affiliation(s)
- Orhan Dogdu
- Erciyes University School of Medicine, Department of Cardiology, Kayseri, Turkey.
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110
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Development of various arrhythmias and conduction disturbances following corticosteroid therapy for systemic lupus erythematosus with antiphospholipid syndrome. Mod Rheumatol 2010; 20:401-4. [DOI: 10.1007/s10165-010-0283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 02/05/2010] [Indexed: 11/25/2022]
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111
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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disorder, with a heterogeneous presentation. Disease severity is wide ranging, with most suffering milder forms; however, it is potentially fatal depending on organ involvement. The disorder was recognized as early as the Middle Ages, with the 12th-century physician Rogerius being the first to apply the term lupus to the classic malar rash, and in 1872, Moric Kaposi first recognized the systemic nature of the disease. Perioperatively, SLE can present major challenges to the anesthesiologist because of accrued organ damage, coagulation defects, and complex management regimes. In this article I highlight adult SLE manifestations and treatments pertinent to the anesthesiologist and discuss perioperative management of these complex patients.
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112
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Bolster L, Taylor-Gjevre RM, Nair B, Gjevre JA. Digital gangrene associated with anticentromere antibodies: a case report. J Med Case Rep 2010; 4:189. [PMID: 20569489 PMCID: PMC2901265 DOI: 10.1186/1752-1947-4-189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 06/22/2010] [Indexed: 11/11/2022] Open
Abstract
Introduction Anticentromere antibodies have been associated with peripheral vascular occlusive disease, most frequently accompanied by sclerodactyly in the context of a connective tissue disorder. We report a case of digital gangrene with no other clinical associations except positive anticentromere antibodies. Case presentation Our patient, a 53-year-old Caucasian woman, non-smoker, presented with progressive pain and blackening of the distal right third finger over the preceding five weeks. No sclerodactyly was evident. She was anticentromere antibody positive at greater than 100 U/mL. Angiography revealed diffuse distal vasculopathy in both upper extremities. Other investigations were unremarkable. Conclusions It is rare for anticentromere antibody-associated digital necrosis to develop without concomitant sclerodactyly. However, this patient's case illustrates the need to consider an autoimmune contribution to the pathogenesis of digital ischemia even in the absence of a recognizable connective tissue disease.
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Affiliation(s)
- Lauren Bolster
- Division of Rheumatology, Department of Internal Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
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113
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Othman KM, Assaf NY, Farouk HM, Aly Hassan IM. Autonomic dysfunction predicts early cardiac affection in patients with systemic sclerosis. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2010; 3:43-54. [PMID: 21124695 PMCID: PMC2989638 DOI: 10.4137/cmamd.s4940] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To detect the early preclinical alterations in cardiac autonomic control as well as altered cardiac function in systemic sclerosis (SSc) patients and their relevance to the clinical features of the disease using noninvasive methods. METHODS 30 SSc patients and 15 healthy controls matched for age and sex underwent clinical examination, serological analysis, and echocardiographic assessment including Doppler flow imaging to evaluate cardiac function, and 24-hour Holter monitoring analyzed for arrhythmia and heart rate variability (HRV) in the time and frequency domains. RESULTS The trans-mitral Doppler of early to atrial wave (E/A) ratio was reversed in five patients (16.6%) and the tricuspid E/A ratio was reversed in 10 patients (33.3%). Holter analysis for SSc patients revealed an increased prevalence of premature ventricular contractions (PVC) ≥ 10/h (P = 0.02), supra-ventricular tachycardias (SVTs) (P = 0.2), and total PVC count (P = 0.0000). Highly significant (P = 0.000) impairment in all HRV parameters was demonstrated in the SSc patients. Total skin thickness score (TSS), Raynaud's phenomenon and anti-scleroderma 70 (anti-SCL70) showed significant positive correlations with all arrhythmia parameters, while showing a significant negative correlation with the impaired ventricular diastolic function and various HRV parameters. No correlation was found between arrhythmia and HRV parameters and disease duration, disease type, or presence of anti-centromere antibodies. CONCLUSION Low heart rate variability, increased TSS and the presence of anti-SCL70 are correlated with preclinical cardiac involvement in SSc patients and may predict the likelihood of malignant arrhythmia and sudden cardiac death. Therefore, noninvasive HRV evaluation before clinical cardiac involvement in these patients might be beneficial when added to the clinical and laboratory assessments in detecting high-risk patients, and may allow for implementation of preventive measures and initiation of appropriate therapy early in the course of the disease.
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Affiliation(s)
| | | | | | - Iman M. Aly Hassan
- Clinical Pathology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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114
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Bienias P, Ciurzyński M, Glińska-Wielochowska M, Korczak D, Kalińska-Bienias A, Gliński W, Pruszczyk P. Heart rate turbulence impairment and ventricular arrhythmias in patients with systemic sclerosis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:920-8. [PMID: 20456648 DOI: 10.1111/j.1540-8159.2010.02779.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arrhythmias, conduction disturbances, and cardiac autonomic nervous system dysfunction are the most frequent cardiovascular complications in systemic sclerosis (scleroderma). The aim of the study was to assess heart rate turbulence (HRT) in systemic sclerosis patients and to identify the relationship between HRT and occurrence of arrhythmias. METHODS Forty-five patients with scleroderma (aged 54.6 +/- 14.7 years) and 30 healthy sex- and age-matched subjects were examined. In addition to routine studies, 24-hour Holter monitoring with assessment of HRT was performed. RESULTS As compared to controls, HRT was significantly impaired in systemic sclerosis patients. Abnormal HRT defined as turbulence onset (TO) > or =0.0% and/or turbulence slope (TS) < or =2.5 ms/RR (ms/RR interval) was found in 19 (42%) scleroderma patients and in no members of the control group. Serious ventricular arrhythmias Lown class IV (VA-LownIV), for example, couplets and/or nonsustained ventricular tachycardias, were observed in 16 (36%) scleroderma patients. The median value of TS was significantly lower in systemic sclerosis patients with VA-LownIV than in patients without VA-LownIV (3.68 vs 7.00 ms/RR, P = 0.02). The area under curve of ROC analysis for prediction of VA-LownIV was 0.72 (95% confidence interval [CI] 0.56-0.87) and revealed that TS <9.0 ms/RR was associated with VA-Lown IV occurrence, with sensitivity of 93.7% and specificity of 44.8%. Univariate and multivariate analyses confirmed that lower values of TS were associated with VA-LownIV occurrence (odds ratio 1.52, 95% CI 1.09-2.12, P = 0.01). CONCLUSIONS Patients with systemic sclerosis are characterized by significant HRT impairment. Assessment of HRT and especially TS is useful in the identification of patients at risk for ventricular arrhythmias.
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Affiliation(s)
- Piotr Bienias
- Department of Internal Medicine and Cardiology, The Medical University of Warsaw, Warsaw, Poland.
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115
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Emkey GR, Stone JH. A 46-year-old woman with chin pain and a fainting spell. Arthritis Care Res (Hoboken) 2010; 62:434-8. [DOI: 10.1002/acr.20093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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116
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Goulenok TM, Meune C, Gossec L, Dougados M, Kahan A, Allanore Y. Usefulness of routine electrocardiography for heart disease screening in patients with spondyloarthropathy or rheumatoid arthritis. Joint Bone Spine 2010; 77:146-50. [PMID: 20189433 DOI: 10.1016/j.jbspin.2010.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the usefulness of routine electrocardiography for heart disease screening in patients with spondyloarthropathy (SpA) or rheumatoid arthritis (RA). METHODS We included consecutive patients with SpA or RA or with degenerative joint disease (control group) admitted over a 6-month period and free of cardiovascular events. A 12-lead electrocardiogram (ECG) was obtained and was interpreted by a cardiologist who was unaware of the diagnosis. RESULTS We included 108 patients with SpA (mean duration, 11+/-10 years), 106 with RA (mean duration, 12+/-9 years), and 74 with degenerative joint disease (controls). No patient had cardiovascular symptoms or a prior history of cardiovascular disease. The only difference in cardiovascular risk factors across the three populations was a higher prevalence of diabetes in the RA and control groups. We found no differences between the SpA or RA groups and the control group regarding the rates of the following ECG findings: premature beats, atrioventricular block (2.8% in the SpA group, 1.9% in the RA group, and 2.7% in the control group), complete or incomplete left bundle branch block (0.9%, 0.9%, and 2.7%, respectively), complete right bundle branch bloc or left bundle branch block (0.9%, 4.7%, and 4.1%, respectively); and abnormalities suggesting myocardial ischemia (10.2%, 19.8%, and 17.6%, respectively). CONCLUSION In patients with SpA or RA who have no cardiovascular symptoms or history of cardiovascular disease, a routine ECG shows no increase in the cardiac abnormalities specifically associated with these joint diseases, compared to controls with degenerative joint disease.
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Affiliation(s)
- Tiphaine Miquel Goulenok
- Services de rhumatologie A, hôpital Cochin, AP-HP, université Paris-Descartes, 27, rue du faubourg 75679 Paris cedex 14, France
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Aydemir M, Yazisiz V, Basarici I, Avci AB, Erbasan F, Belgi A, Terzioglu E. Cardiac autonomic profile in rheumatoid arthritis and systemic lupus erythematosus. Lupus 2009; 19:255-61. [PMID: 20015916 DOI: 10.1177/0961203309351540] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neurological involvement is a well-documented issue in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, little is known about the involvement of the autonomic nervous system. This study was conducted to investigate autonomic nervous system dysfunction in patients with RA and SLE. Twenty-six RA patients, 38 SLE patients and 40 healthy controls were recruited from our in- and out-patient departments. Heart rate variability (HRV) parameters (the power of the high- [HF] and low-frequency [LF] band of haemodynamic time series, the ratio between low- and high-frequency components [LF/HF ratio], the power spectral density), baroreflex sensitivity (BRS) and beat-to-beat blood pressures were assessed by a novel non-invasive haemodynamic monitoring tool (Task Force Monitor [TFM], CNSystems Medizintechnik GmbH, Graz, Austria). Autonomic nervous system dysfunction was determined according to classical Ewing autonomic test battery. Furthermore, we implemented a secondary autonomic test score by modifying the Ewing test battery with additional criteria. Both the classical and modified Ewing test batteries have revealed that the frequencies of autonomic neuropathy were significantly higher in patient groups compared with controls (p < 0.001). Evaluation by TFM revealed that deterioration of sophisticated autonomic parameters (such as HRV and BRS) were more pronounced in the patient groups compared with controls. There was a significant association between BRS and Ewing test scores and abnormal BRS results were more frequent in patients with autonomic dysfunction according to Ewing test batteries. No relation was found between autonomic neuropathy and disease duration, disease activity and autoantibody positivity. Consequently, we believe that further large-scale studies investigating cardiovascular autonomic neuropathy in rheumatic diseases should be carried out to verify our findings and manifest clinical consequences beyond these results.
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Affiliation(s)
- M Aydemir
- Carşamba Government Hospital, Carşamba, Samsun, Turkey
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118
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Bienias P, Ciurzyński M, Glińska-Wielochowska M, Szewczyk A, Korczak D, Kalińska-Bienias A, Gliński W, Pruszczyk P. Heart rate turbulence assessment in systemic sclerosis: the role for the detection of cardiac autonomic nervous system dysfunction. Rheumatology (Oxford) 2009; 49:355-60. [PMID: 20007288 DOI: 10.1093/rheumatology/kep394] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the heart rate turbulence (HRT) in patients with SSc as a method of assessment for cardiac autonomic nervous function. METHODS We prospectively studied 68 consecutive patients with SSc before inclusion in the study. After a detailed clinical evaluation, including echocardiography, 45 subjects [aged 54.6 (14.7) years; 40 women] underwent 24-h Holter monitoring for HRT and time- and frequency-domain heart rate variability (HRV) assessment. Results were compared with those in 30 age- and sex-matched healthy controls. RESULTS As compared with controls, HRT was impaired in SSc patients: the median turbulence onset (TO) was higher (P = 0.0001) and the median turbulence slope (TS) was lower (P = 0.0003). Abnormal HRT (TO > or =0.0% and/or TS < or =2.5 ms/RR) was found in 42% of SSc patients. Moreover, SSc duration correlated negatively with values of TS (r = -0.3; P = 0.045). HRT did not differ between diffuse and limited SSc groups. All estimated time- and the majority of frequency-domain values of HRV parameters in SSc were significantly lower than in controls. Significant correlations were also demonstrated between HRT and HRV parameters. CONCLUSIONS HRT, like HRV assessment, indicates a frequent impairment of the cardiac autonomic nervous system in SSc patients, irrespective of the SSc type.
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Affiliation(s)
- Piotr Bienias
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-005 Warsaw, Lindleya 4, Poland.
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119
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Moyssakis I, Lionakis N, Vlahodimitris I, Votteas V. Complete heart block and severe aortic stenosis in a patient with rheumatoid arthtritis: a case report. CASES JOURNAL 2009; 2:126. [PMID: 19196455 PMCID: PMC2642791 DOI: 10.1186/1757-1626-2-126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 02/05/2009] [Indexed: 11/25/2022]
Abstract
Background A 77-year-old male patient with a history of rheumatoid arthritis was admitted to our hospital for investigation of syncope and dyspnea on exertion class II according to NYHA class association. Case presentation The electrocardiogram revealed complete heart block whereas the echocardiogram showed severe aortic valve stenosis with a peak gradient = 80 mmHg. A permanent pacemaker was implanted in addition to aortic valve replacement. The coexistence of complete heart block and severe aortic stenosis with rheumatoid arthritis are presented. Conclusion Further studies are necessary to assess whether a true association of the above conditions exist.
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120
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Chronister CS. Congenital complete atrioventricular block in a young man: a case study. Crit Care Nurse 2009; 29:45-56; quiz 1 p following 56. [PMID: 19797494 DOI: 10.4037/ccn2009297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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121
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Adenosine Triphosphate-sensitive Micro-reentrant Atrial Tachycardia Originating from the Crista Terminalis in a Patient with Chronic Renal Failure due to Thrombotic Thrombocytopenic Purpura. J Arrhythm 2009. [DOI: 10.1016/s1880-4276(09)80004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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122
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Ferraro A, Masi AS, Mazza A, Brusin MR, Conte M. Increased stimulation threshold in a patient with autoimmune disease: successful management with oral prednisolone and azathioprine. Europace 2008; 11:527-9. [DOI: 10.1093/europace/eup010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Makaryus JN, Catanzaro JN, Goldberg S, Makaryus AN. Rapid progression of atrioventricular nodal blockade in a patient with systemic lupus erythematosus. Am J Emerg Med 2008; 26:967.e5-7. [PMID: 18926371 DOI: 10.1016/j.ajem.2008.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Accepted: 02/09/2008] [Indexed: 10/21/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a multisystem disorder with numerous potential adverse effects on the cardiovascular system. These complications likely develop in most patients with SLE at some time during the course of their disease, in part due to the decreased mortality associated with SLE as a result of modem medical management. Conduction disturbances have been reported in the literature to occur primarily from the progression of SLE and secondarily from pharmacotherapy used to treat SLE and may first be evident on the electrocardiogram in the emergency department (ED) setting. Electrocardiogram abnormalities such as borderline first-degree heart block may be clues to more significant cardiac disease brought upon by years of chronic inflammation, myocarditis, vasculitis, and fibrosis that are often the result of longstanding autoimmune disease. It is essential that patients with autoimmune disease be screened carefully in the ED setting for underlying myocardial disease, particularly given the increased potential for atherosclerosis, ischemia, arrhythmias, and myocardial conduction defects in these patients.
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Affiliation(s)
- John N Makaryus
- Department of Medicine, Division of Cardiology, North Shore University Hospital, Manhasset, NY 11030, USA.
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Pappas DA, Taube JM, Bathon JM, Giles JT. A 73-year-old woman with rheumatoid arthritis and shortness of breath. ACTA ACUST UNITED AC 2008; 59:892-9. [DOI: 10.1002/art.23720] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Matucci-Cerinic M, Seferović PM. Heart involvement in autoimmune rheumatic diseases: the "phantom of the opera". Rheumatology (Oxford) 2007; 45 Suppl 4:iv1-3. [PMID: 16980716 DOI: 10.1093/rheumatology/kel316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Matucci-Cerinic
- Department of Medicine and Surgery, Division of Medicine I and Rheumatology University of Florence, AOUC, Florence, Italy.
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