Myocardial Involvement in Generalized Scleroderma

The Heart in Scleroderma

“…7B). Sometimes there are so many capillaries present that the histological appearance resembles that of young granulation tissue as in the patient described by Hurley et al (1951), but later extensive hyaline scarring appears.…”

“…It is not uncommon for the heart silhouette to be normal, notwithstanding electrocardiographic evidence of myocardial involvement. Most of Goetz's (1951) patients had a normal cardiac silhouette, although the kymogram showed blunting of the cardiac excursions in four of them, and in three that came to autopsy the lesion was confirmed histologically. Lung Radiological Findings.…”

“…Five patients in our series presented in this manner (Table IV). Other reported examples are those of Goldman et al (1954) who r ecorded an example in a man aged 50, where cardiac symptoms were present for about 30 months, and only during the last 6 months of life did the diagnosis of scleroderma become obvious. Similarly, in three of the nine cases described by Weiss et al (1943) cardiac symptoms preceded changes in the skin, as they did also in the case of Spain and Thomas (1950) and that of Bauer (1955).…”

“…From microscopical studies it appears to be the exception for hypertension to result from renal involvement (Moore and Sheehan, 1952); in fact, several authors, among them Gil (1951) and Goetz (1951), have emphasized the tendency of the blood pressure to drop as the disease progresses. Even so, when hypertension is severe, retinal exudates and hamorrhages may accompany it, and it may constitute the cause of death (Ellman, 1938).…”

“…Sinus rhythm is the rule, but extrasystoles, usually ventricular and sometimes multifocal, are very frequent. Partial heart block (Weiss et al, 1943), which at times may proceed to become complete (East and Oram, 1947), has been noted, and both right bundle-branch block (Goldman et al, 1954) and left (Weiss et al, 1943) have appeared. Right bundle-branch block may at times be transient as in one of our patients, or at other times it appears gradually over a period of months or years (Fig.…”