Cardiac Manifestations of Rheumatological Conditions: A Narrative Review

Abstract

Cardiovascular diseases are common in systemic rheumatologic diseases. They can be presented at the time of diagnosis or after diagnosis. The cardiac involvements can be the first presentation of rheumatologic conditions. It means that a patient with rheumatologic disease may go to a cardiologist when attacked by this disease at first. These manifestations are very different and involve different structures of the heart, and they can cause mortality and morbidity of patients with rheumatologic diseases. Cardiac involvements in these patients vary from subclinical to severe manifestations. They may need aggressive immunosuppressive therapy. The diagnosis of these conditions is very important for choosing the best treatment. Premature atherosclerosis and ischemic heart disease are increased in rheumatoid arthritis and systemic lupus erythematosus, and may be causes of mortality among them. The aggressive control of systemic inflammation in these diseases can reduce the risk of cardiovascular disease especially ischemic heart disease. Although aggressive treatment of primary rheumatologic diseases can decrease mortality rate and improve them, at this time, there are no specific guidelines and recommendations, to include aggressive control and prevention of traditional risk factors, for them.

Cardiorheumatology: cardiac involvement in systemic rheumatic disease

“…Not all myocardial manifestations of rheumatological conditions are clinically relevant, but myocardial involvement can confer considerable morbidity and mortality 38,63…”

Cardiac tamponade in a patient with ankylosing spondylitis: a notable response to TNF inhibitors

“…Approximately 1 to 2 per 1000 among whites are affected by AS, with a 3:1 to 4:1 male predominance. Its onset is usually in the third to fourth decades 1. A previous case of AS with recurrent pleural and pericardial effusion which the patient responded to prednisolone treatment was reported in literature 2.…”

“…Categorised as a seronegative spondyloarthropathy, the underlying disease process entails inflammation of the enthesis, sites where tendons and ligaments attach to bone 1. As a systemic disease, it may have other manifestations such as uveitis, fibrocavitary apical lung lesions and cardiac manifestations.…”

Atherosclerosis and Other Cardiovascular Manifestations of Rheumatologic Diseases

“…Likely one of the most well established cardiac manifestations of (RA) is premature atherosclerosis and ischemic heart disease leading to disproportionate mortality in RA due to Cardiovascular Disease (CVD) [1][2][3][4]. Studies have shown greater than two-fold increase in myocardial infarction and worse outcomes compared to controls [5][6][7][8][9].…”