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Cardiac manifestations of rheumatological disease: a synopsis for the cardiologist
  1. Gautam Sen1,
  2. Patrick Gordon2,
  3. Daniel M Sado1
  1. 1 Cardiology, King's College Hospital NHS Foundation Trust, London, UK
  2. 2 Department of Rheumatology, King's College Hospital, London, UK
  1. Correspondence to Dr Daniel M Sado, Cardiology, King's College Hospital NHS Foundation Trust, London SE59RS, UK; danielsado{at}nhs.net

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Learning objectives

  • The aim of this review is to educate the reader in the various rheumatological diseases that can affect the heart.

  • These will be discussed in some detail, along with suggestions for how to investigate and manage patients with these problems.

  • Lastly, the importance of close working between the rheumatologist and cardiologist is a key learning objective throughout the article.

Introduction

Cardiovascular (CV) manifestations of autoimmune systemic rheumatic diseases have become increasingly recognised and have the potential to involve any part of the heart including the myocardium, the pericardium, the valves and the conduction system.1 Symptoms can be mild and initially clinically silent, but in the long term can result in life-threatening complications. Guidelines on the diagnosis and management of specific rheumatological conditions in the UK can be found on the British Society of Rheumatology website. In this review, we explore the CV manifestations of autoimmune rheumatological diseases and highlight the need to raise awareness of the emerging field of cardio-rheumatology.

The review explores the CV manifestations of a range of connective tissue diseases (CTDs) including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), systemic sclerosis (SS), autoimmune myositis and the vasculitides. Due to limitation on space, we do not cover the seronegative spondyloarthropathies, sarcoidosis and gout. We will also not cover the cardiovascular manifestations of genetic CTDs such as Marfan’s disease and the genetic autoinflammatory conditions such as familial Mediterranean fever.

The workup of cardiac disease in patients with autoimmune disorders

The range of CV manifestations of rheumatological diseases are broad and include but are not restricted to coronary artery disease (CAD), valve disease, myocarditis, pericarditis, heart failure and rhythm disturbances. While these problems are familiar to the cardiologist, in the context of certain rheumatological diseases, different treatment strategies and screening approaches are required.

Coronary artery disease

Broadly speaking, CAD can be asymptomatic, result in stable chronic symptoms or cause acute …

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Footnotes

  • Contributors GS wrote the original draft under guidance from DMS/PG who then both reviewed this and made changes.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note References which include a * are considered to be key references

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