How lupus affects the heart and circulation
Your heart, blood vessels, and lungs make up your cardiovascular/pulmonary network: "Cardio" refers to the heart, "vascular" refers to the arteries, veins, and capillaries, and “pulmonary” refers to the lungs. Your blood circulates through this vast system, transporting oxygen and other elements needed for your cells and tissues to function properly. Cardiologists are the physicians who specialize in the heart. Pulmonologists are the physicians who specialize in the lungs.
Heart disease is a major complication of lupus. It is now a leading cause of death among people with lupus. Blood tests, chest X-rays, an electrocardiogram (EKG), or an echocardiogram may be used to find out if you have a heart condition caused by lupus.
The most common way that lupus affects the heart is through inflammation of the pericardium, the sac that surrounds your heart. The symptoms of pericarditis that you may experience are sharp pain in your chest and occasionally, shortness of breath. Pericarditis usually does not damage your heart’s ability to function because it does not directly involve the heart tissue. However, inflammation that is chronic (long-lasting) can scar the heart tissue, which can interfere with the heart’s ability to pump blood.
Lupus can cause inflammation of the myocardium, the muscle tissue of your heart. The symptoms are chest pain and an unexplained rapid or irregular heart beat. Myocarditis is often seen when there is inflammation in other muscles in the body.
However, myocarditis can be caused by viral, bacterial, and fungal infections. Because lupus itself creates an added risk for developing infections -- especially if you are taking certain immunosuppressive drugs -- you are at increased risk for this type of myocarditis.
Though serious heart muscle disease is not commonly caused by lupus, heart failure can occur if your heart does not have the strength to pump enough blood to the different tissues and organs.
The endocardium is the tissue that lines the inner walls of your heart and the valves that separate the heart’s different chambers. Lupus can cause inflammation of the endocardium. Lupus endocarditis usually causes the surfaces of the heart valve to thicken or develop wart-like growths (lesions). These lesions can become infected, a condition called bacterial endocarditis. A lesion also could break off and travel to the brain to form a blood clot. Both of these possibilities are potentially very dangerous.
Coronary artery disease
The coronary arteries move blood to and from your heart. Over time, fatty molecules and other materials may attach to the walls of these blood vessels and form plaque, which makes the blood vessels narrower and restricts blood flow. This condition is known as atherosclerosis. A decrease in blood flow can cause angina (chest pain). However, if the blood flow to your heart is interrupted -- either by plaque or by a blood clot that develops when plaque breaks off -- you could be at risk for a heart attack.
When you have lupus, you are at increased risk for coronary artery disease. This is partly because people with lupus have more risk factors, which may include:
- Hypertension from kidney disease or corticosteroid use
- Elevated cholesterol levels from corticosteroid use
- Type 2 diabetes from corticosteroid use
- An inactive, sedentary lifestyle due to fatigue, joint problems, and/or muscle pain
However, even after taking these risk factors into account, people with lupus are more likely to develop atherosclerosis. You can help reduce your chances of heart attacks and other complications from coronary artery disease in several ways:
- Control the risk factors
- Control the lupus disease activity
- Talk with your doctor about reducing or stopping corticosteroid use
The circulatory system
Inflammation in a small blood vessel like a capillary may cause that vessel to break and bleed inside the tissue. Inflammation that occurs in the skin may appear as a small red or purple dot. Inflammation that takes place in other tissues can be extremely serious, especially within the brain. Vasculitis is caused by inflammation of the blood vessel walls. The symptoms of lupus-induced vasculitis that you may experience can vary depending upon which tissues are involved, but may include:
- Feeling ill
- Poor appetite
- Weight loss
- Blurry vision
- Behavioral disturbances