Heart disease in scleroderma

[Pathology of diseases of extracardiac origin. VI. Disease of the connective tissue and heart]

Connective tissue diseases encompass a wide group of nosologic entities of unknown etiology, characterized by multisystemic organ involvement, sharing an immunologic pathogenetic mechanism, producing a variety of inflammatory manifestations, and whose primary lesion is always a diffuse vasculitis. Any part of the cardiovascular system may be involved, including the pericardium, the myocardium, the endocardium and valves, the coronary arteries, the aorta, the pulmonary vasculature, the peripheral arteries, veins, arterioles, venules, and the capillary beds of almost every organ subsystem. Pathologic studies disclose a high prevalence of heart involvement, but the presence and extent of pathologic findings correlate poorly with clinical manifestations. With the advent of echocardiography-Doppler, milder and earlier cases are now recognized. Although these patients continue under the care of rheumatologists and internists, when cardiac involvement arises, cardiologists must be aware of the characteristics, outcome and management of connective tissue diseases.

Comprehensive noninvasive assessment of cardiac involvement in limited systemic sclerosis

OBJECTIVE

To assess cardiovascular abnormalities in patients with limited systemic sclerosis (SSc), using noninvasive cardiac techniques.

METHODS

Sixty-three patients with limited SSc were prospectively evaluated with Doppler echocardiography and thallium-201 perfusion scintigraphy after a cold-stress test and radionuclide ventriculography.

RESULTS

In the patients with limited SSc, there was a significantly high prevalence of abnormal left- and right-diastolic function parameters (P = 0.001 and P = 0.0002, respectively), thickening of papillary muscles (46%; P = 0.003), and mild mitral regurgitation (49%; P < 0.0001), compared with controls. Systolic pulmonary arterial hypertension was detected in 9 patients (14%), and pericardial effusion in 11 patients (18%). In 64% of patients with limited SSc, an ischemic response was detected on the thallium cold-stress scan; similarly, an ischemic response was detected in 57% of patients with primary Raynaud's phenomenon (P < 0.0001 versus controls).

CONCLUSION

Although the frequency of cardiovascular symptoms was low in patients with limited SSc, a significant rate of cardiovascular abnormalities was found by noninvasive cardiac techniques.

Sinus arrest developed during gastric cancer operation in a progressive systemic sclerosis patient

We report a case of progressive systemic sclerosis (PSS) who suddenly developed sinus arrest during an operation for gastric cancer under general anesthesia. No abnormalities in her cardiac, respiratory or renal functions had been detected before surgery. The cardiac functions evaluated by echocardiogram before and after pacemaking eliminated heart muscular involvement. We speculated that the operation stress induced by general anesthesia altered the asymptomatic fibrotic sinus into apparent sinus dysfunction. Care should be taken in general anesthesia for scleroderma patients who are free from detectable cardiac manifestations.