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1, Pathophysiology of SLE and the Cardiovascular System

Systemic lupus erythematosus (SLE) is an autoimmune disease that causes inflammation and damage to different organs. Cardiovascular complications can occur because chronic inflammation damages blood vessels and increases the risk of atherosclerosis. Patients with SLE may also be at risk for developing pericarditis, myocarditis, or thrombosis, especially when antiphospholipid antibodies are present. Traditional risk factors, including hypertension, high cholesterol, smoking, and obesity, can further increase cardiovascular risk (Ambler & Kaplan, 2024).

  1. Symptoms and Clinical Manifestations

Cardiovascular symptoms of SLE may include chest pain, shortness of breath, fatigue, palpitations, edema, and hypertension. Pericarditis can cause sharp chest pain, while myocarditis may affect heart function and lead to heart failure. SLE can also increase the risk of heart attacks and strokes at a younger age. Other complications, such as lupus nephritis, may contribute to hypertension and increase cardiovascular risk, showing why SLE requires a “whole-body” assessment (Ambler & Kaplan, 2024).

  1. Diagnostic Testing

Diagnostic testing may include blood pressure monitoring, lipid panels, ECGs, echocardiograms, and cardiac biomarkers such as troponin, depending on the patient’s symptoms. Antiphospholipid antibody testing may also be appropriate when thrombosis is suspected or risk needs to be assessed. Since symptoms like fatigue and shortness of breath can have multiple causes, providers should also consider renal, pulmonary, and other systemic manifestations.

  1. Treatment and Management

Treatment focuses on controlling inflammation, preventing cardiovascular complications, and managing risk factors. Hydroxychloroquine is commonly used to manage SLE, while other immunosuppressive medications may be needed depending on the organ involvement. Managing blood pressure and cholesterol, exercising, maintaining a healthy diet, and avoiding smoking are also important. Patients with antiphospholipid syndrome may need antithrombotic therapy based on their individual history. Overall, managing SLE requires ongoing monitoring and a multidisciplinary approach (Fanouriakis, 2024).

References

Ambler, W. G., & Kaplan, M. J. (2024). Vascular damage in systemic lupus erythematosus. Nature Reviews Nephrology, 20, 251–265. https://doi.org/10.1038/s41581-023-00797-8

Fanouriakis, A., et al. (2024). EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Annals of the Rheumatic Diseases, 83(1), 15–29. https://doi.org/10.1136/ard-2023-224762

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