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<title>Systemic lupus erythematosus presenting with cardiac symptoms - The American Journal of Emergency Medicine</title>
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<meta name="citation_journal_title" content="The American Journal of Emergency Medicine"/> <meta name="citation_journal_abbrev" content="The American Journal of Emergency Medicine"/> <meta name="citation_publisher" content="Elsevier"/> <meta name="citation_title" content="Systemic lupus erythematosus presenting with cardiac symptoms"/> <meta name="citation_date" content="2014/09/01"/> <meta name="citation_online_date" content="2014/07/01"/> <meta name="citation_volume" content="32"/> <meta name="citation_issue" content="9"/> <meta name="citation_firstpage" content="1117"/> <meta name="citation_lastpage" content="1119"/> <meta name="citation_pmid" content="25082598"/> <meta name="citation_abstract_html_url" content="http://www.ajemjournal.com/article/S0735675714004884/abstract"/> <meta name="citation_fulltext_html_url" content="http://www.ajemjournal.com/article/S0735675714004884/fulltext"/> <meta name="citation_pdf_url" content="http://www.ajemjournal.com/article/S0735675714004884/pdf"/> <meta name="citation_issn" content="0735-6757"/> <meta name="citation_issn" content="1532-8171"/> <meta name="citation_language" content="English"/> <meta name="citation_doi" content="10.1016/j.ajem.2014.06.036"/> <meta name="citation_pmid" content="25082598"/> <meta name="citation_author" content="Ping-Yuan Chen"> <meta name="citation_author_institution" content="Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan"> <meta name="citation_author" content="Ching-Hung Chang"> <meta name="citation_author_institution" content="Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan"> <meta name="citation_author" content="Chien-Chin Hsu"> <meta name="citation_author_institution" content="Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan"> <meta name="citation_author_institution" content="Department of Biotechnology, Southern Tainan University of Technology, Tainan, Taiwan"> <meta name="citation_author" content="Yu-Ying Liao"> <meta name="citation_author_institution" content="Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan"> <meta name="citation_author" content="Kuo-Tai Chen"> <meta name="citation_author_email" content="890502@mail.chimei.org.tw"> <meta name="citation_author_institution" content="Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan"> <meta name="citation_author_institution" content="Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan"> <meta name="citation_reference" content="citation_title=Cardiac involvement in systemic lupus erythematosus; citation_author=A. Doria; citation_author=L. Iaccarino; citation_author=P. Sarzi-Puttini; citation_author=F. Atzeni; citation_author=M. Turriel; citation_author=M. Petri; citation_journal_title=Lupus; citation_volume=14; citation_firstpage=683; citation_lastpage=686; citation_publication_date=2005; "> <meta name="citation_reference" content="citation_title=Cardiac involvement in systemic lupus erythematosus; citation_author=K.G. Moder; citation_author=T.D. Miller; citation_author=H.D. Tazelaar; citation_journal_title=Mayo Clin Proc; citation_volume=74; citation_firstpage=275; citation_lastpage=284; citation_publication_date=1999; "> <meta name="citation_reference" content="citation_title=Cardiac involvement in systemic autoimmune diseases; citation_author=P. Riboldi; citation_author=M. Gerosa; citation_author=C. Luzzana; citation_author=L. Catelli; citation_journal_title=Clin Rev Allergy Immunol; citation_volume=23; citation_firstpage=247; citation_lastpage=261; citation_publication_date=2002; "> <meta name="citation_reference" content="citation_title=Cardiac involvement in systemic rheumatic diseases: an update; citation_author=P. Sarzi-Puttini; citation_author=F. Atzeni; citation_author=R. Gerli; citation_author=E. Bartoloni; citation_author=A. Doria; citation_author=T. Barskova; citation_author=et al.; citation_journal_title=Autoimmun Rev; citation_volume=9; citation_firstpage=849; citation_lastpage=852; citation_publication_date=2010; "> <meta name="citation_reference" content="citation_title=The 1982 revised criteria for the classification of systemic lupus erythematosus; citation_author=E.M. Tan; citation_author=A.S. Cohen; citation_author=J.F. Fries; citation_author=A.T. Masi; citation_author=D.J. McShane; citation_author=N.F. Rothfiled; citation_author=et al.; citation_journal_title=Arthritis Rheum; citation_volume=25; citation_firstpage=1271; citation_lastpage=1277; citation_publication_date=1982; "> <meta name="citation_reference" content="citation_title=Acute lupus myocarditis: clinical features and outcome of an oriental case series; citation_author=W.G. Law; citation_author=B.Y. Thong; citation_author=T.Y. Lian; citation_author=K.O. Kong; citation_author=H.H. Chng; citation_journal_title=Lupus; citation_volume=14; citation_firstpage=827; citation_lastpage=831; citation_publication_date=2005; "> <meta name="citation_reference" content="citation_title=An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus; citation_author=C.A. Roldan; citation_author=B.K. Shively; citation_author=M.H. 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                <div class="artInfoWrapper"><div class="articleInfo"><div class="switchViewMode"><a href="#" class="toStandard">Switch to Standard View</a><a href="#" class="toEnhanced">Switch to Enhanced View</a></div><h1 class="articleTitle"><h1 class="articleTitle">Systemic lupus erythematosus presenting with cardiac symptoms</h1></h1><div class="authorGroup"><div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_au0005" href="javascript:void(0);">Ping-Yuan Chen</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="au0005_compliance" tabindex="-1" data-target="au0005"><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="au0005_compliance">Ping-Yuan Chen</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan</li></ul></div></div>, MD</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_au0010" href="javascript:void(0);">Ching-Hung Chang</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="au0010_compliance" tabindex="-1" data-target="au0010"><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="au0010_compliance">Ching-Hung Chang</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan</li></ul></div></div>, MD</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_au0015" href="javascript:void(0);">Chien-Chin Hsu</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="au0015_compliance" tabindex="-1" data-target="au0015"><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="au0015_compliance">Chien-Chin Hsu</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan</li></ul><ul class="affiliations"><li>Department of Biotechnology, Southern Tainan University of Technology, Tainan, Taiwan</li></ul></div></div>, MD, PhD</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_au0020" href="javascript:void(0);">Yu-Ying Liao</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="au0020_compliance" tabindex="-1" data-target="au0020"><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="au0020_compliance">Yu-Ying Liao</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan</li></ul></div></div>, MD</div>,<div class="author"> <a class="openAuthorLayer layerTrigger" id="openAuthor_au0025" href="javascript:void(0);">Kuo-Tai Chen</a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="au0025_compliance" tabindex="-1" data-target="au0025"><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="au0025_compliance">Kuo-Tai Chen</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan</li></ul><ul class="affiliations"><li>Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan</li></ul><h4>Correspondence</h4><ul class="correspondence"><li>Corresponding author. Emergency Department, Chi-Mei Medical Center, 901 Chung-Hwa Road, Yung Kang, Tainan 710, Taiwan. Tel.: +<span style="display:inline-block;width:0.10em;"></span>886 6 2812811x57196; fax: +<span style="display:inline-block;width:0.10em;"></span>886 6 2816161.</li></ul></div></div>, MD<a class="openAuthorLayer layerTrigger" id="openAuthor_au0025" href="javascript:void(0);"><img src="../../templates/jsp/_style2/_marlin/images/article_notepad.gif" alt="correspondence"></img></a><div class="authorLayer hoverLayer notCollab" role="alertdialog" aria-describedby="au0025_compliance" tabindex="-1" data-target="au0025"><span class="closeBtn" role="button" tabindex="0" aria-label="close window">x</span><div class="header" id="au0025_compliance">Kuo-Tai Chen</div><div><a href="/">Search for articles by this author</a><h4>Affiliations</h4><ul class="affiliations"><li>Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan</li></ul><ul class="affiliations"><li>Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan</li></ul><h4>Correspondence</h4><ul class="correspondence"><li>Corresponding author. Emergency Department, Chi-Mei Medical Center, 901 Chung-Hwa Road, Yung Kang, Tainan 710, Taiwan. Tel.: +<span style="display:inline-block;width:0.10em;"></span>886 6 2812811x57196; fax: +<span style="display:inline-block;width:0.10em;"></span>886 6 2816161.</li></ul></div></div><a class="email" href="mailto:890502@mail.chimei.org.tw" title="Email the author"><img src="../../templates/jsp/_style2/_marlin/images/icon_email.png" alt="email"></img></a></div></div><div class="oaAltContainer"><span class="altmetric-embed" data-doi="10.1016/j.ajem.2014.06.036" data-link-target="_blank"></span></div><div class="doi">DOI:
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                    </div><section class="widget widget-regular abstractImages"><header class="widget-header header-regular">Figures</header><div class="widget-body body body-regular"><div class="image"><div><img src="../../cms/attachment/2018154043/2038330467/gr1.sml.jpg"></img></div><div class="caption"><p class="caption-title"><span class="label">Fig</span></p><p>The most common symptoms of patients with SLE.</p></div></div></div></section><section id="ab0010" class="articleHighlights"><h2 class="sectionTitle">Highlights</h2><div class="content"><p><ul class="ce-list" id="l0005"><li id="u0005"><span class="label">•</span>Patients with cardiac symptoms without a history of cardiopulmonary disease or traditional cardiovascular disease risk factors should be assessed for occult autoimmune diseases.</li><li id="u0010"><span class="label">•</span>Renal and hematologic abnormalities are most common associated findings in SLE patients with cardiac manifestations.</li><li id="u0015"><span class="label">•</span>The presence of cardiac symptoms accompanies with flares of SLE.</li><li id="u0020"><span class="label">•</span>Early diagnosis and initiation of treatment of SLE often leads to a rapid recovery of the cardiac abnormalities.</li></ul></p></div></section><div class="abstract"><h2 class="sectionTitle">Abstract</h2><h3 class="sectionTitle">Background</h3><p>The objective of this study was to describe the characteristics of patients presenting to the emergency department with cardiac symptoms subsequently diagnosed to have systemic lupus erythematosus (SLE).</p><h3 class="sectionTitle">Methods</h3><p>The authors performed a review of newly diagnosed SLE patients at 2 hospitals in Tainan city between January 2010 and December 2013. Patients initially presenting with cardiac symptoms were included. Demographic data, presenting symptomatology, laboratory data, and imaging studies were obtained and analyzed.</p><h3 class="sectionTitle">Results</h3><p>Eight cases, including 5 female and 3 male patients, were identified during the 4-year study period. The mean age was 37 (range, 15-54) years. Pericardial effusion (63%) and mitral regurgitation (63%) were the most common cardiac abnormalities, followed by impairment of left ventricular systolic function (25%) and tricuspid regurgitation (13%). Most patients showed signs of increased generalized inflammation and immunological activity with elevated levels of C-reactive protein (100%) and anti-dsDNA (88%) and decreased complement levels (63%). The median duration from admission to the diagnosis of SLE was 6.3 (range, 1-13) days, and all patients showed multiple-organ involvement in addition to the cardiovascular system.</p><h3 class="sectionTitle">Conclusions</h3><p>Patients presenting to the emergency department with cardiac symptoms without a history of cardiopulmonary disease or traditional cardiovascular disease risk factors should be assessed for an underlying cause of cardiac decompensation. If the patients exhibit extracardiac manifestations or their illnesses involve multiple-organ systems, screening tests for autoimmune diseases such as SLE are mandatory.</p></div><div class="content"></div><div class="denialInfo">
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