Cardiac manifestations of rheumatological disease: a synopsis for the cardiologist
Gautam Sen, Patrick Gordon, Daniel Sado
Abstract
### Learning objectives 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 …