Systemic lupus erythematosus was originally described by a dermatologist (Kaposi, 1872). The cardiac manifestations of this disease were first noticed by Libman in 1911 and published with Sacks in 1924 (4 cases). Recognition of the full clinical picture and of the interrelationship of the various aspects of the disease was achieved by the Mt. Sinai group in the years 1923-1935 (see Baehr et al., 1935). The first account of the pathology of the cardiac lesions was based on 11 cases (Gross, 1932). Systemic lupus erythematosus appears to be less common in the British Isles than in the U.S.A., but it has received more attention here in recent years. With wider recognition of the disease the incidence of heart damage has been found to be greater: Humphreys (1948) found cardiac abnormalities in most of 21 cases studied at necropsy, and Harvey et al. (1954) found that 55 per cent of 138 patients had cardiac abnormalities at some stage of their illness, the commonest finding being pericarditis. Our own observations also show a high incidence of cardiac abnormalities in systemic lupus erythematosus. Heart lesions develop in nearly all patients at some time during the course of their disease when life is prolonged by modern antibiotic and steroid therapy. MATERIAL AND METHODS Sixty patients have been studied in hospital* in the past ten years. Their ages range from 10 to 54. Only four were female. The diagnosis was based on a combination of features such as polyarthritis, lupus rash, fever, and renal, cardiac, or pulmonary involvement, and a raised sedimentation rate. The incidence of the important systemic manifestations is shown in Table 1. In 50 patients TABLE I INCIDENCE OF NON-CARDIAC MANIFESTATIONS IN 60 PATIENTS WITH

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The changing prevalence of the aetiological factors in disease is clearly seen in pericarditis. Tuberculosis, pyogenic infection, and rheumatic fever are now relatively rare causes of this condition in Great Britain. Nowadays pericarditis commonly occurs in a relatively benign isolated form, which is often recurrent and of obscure origin (idiopathic pericarditis): virus infection is often implicated but rarely proved. Recurrent pericarditis also occurs as the dominant feature of the postcardiotomy and post-infarction syndromes, and it is common in the so-called collagen diseases. This report concerns observations on a series of patients with idiopathic, postinfarction, and post-cardiotomy pericarditis. It is concluded, as in a previous report on the post-cardiotomy syndrome (Robinson and Brigden, 1963), that there is often good evidence of a hypersensitivity state in these non-pyogenic forms of pericarditis, especially when the disease is recurrent.The Patients This report is based on 20 patients with idiopathic pericarditis, and reference is made to five patients with postinfarction pericarditis and to 16 others with post-cardiotomy syndrome. Patients with pericarditis due to tuberctilosis and those with pericarditis due to known connective tissue disease such as rheumatoid arthritis and lupus erythematosus, or to a metabolic disorder such as uraemia, seen during the same period were excluded. All were admitted to hospital at some time during the illness and all had unequivocal evidence of pericardial inflammation. Their ages ranged from 13 to 70 (paediatric cases were not included). In 'the idiopathic group the average age was 37 and there was a 2: 1 preponderance of males. In the post-cardiotomy group the average age was 42 and there was a preponderance of females (most operations were on patients with rheumatic mitral valve disease). The average age of the post-infarction group was 55 and all were men. All had had several clinical examinations, electrocardiograms, x-ray films, simple hiematological tests, and serial E.S.R.s. Most had had tests for antiheart antibodies with tanned red cells (T.R.C.T.), some had had virus studies, and some had had tests for myocardial enzymes in the serum. Case ReportsThe