Acute Heart Failure and Systemic Diseases

Acute heart failure in systemic lupus erythematosus (SLE) may result from myocarditis, endocarditis, systemic hypertension, coronary artery disease, and left ventricular dysfunction secondary to drug toxicity. Pericarditis is an early and common cardiac manifestation of active lupus. Moderate to severe pericardial disease is infrequent (1), and constrictive pericarditis is rare. Pericardial fluid is usually exudative (1), and may contain anti-DNA antibodies, with low complement levels. Treatment includes nonsteroidal antiinflammatory drugs (NSAIDs) or corticosteroids in mild pericarditis (2). In cardiac tamponade, higher corticosteroid doses are needed, and often intravenous bolus and invasive procedures (pericardiocentesis, pericardial window, or pericardial stripping) are considered. In patients with relapsing pericarditis, methotrexate, azathioprine, and intravenous immunoglobulins (IVIGs) may be beneficial.