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Fogaça da Mata M, Rebelo M, Sousa HS, Rocha A, Miguel P, Oliveira Ramos F, Costa-Reis P. Sinus node disfunction in an adolescent with systemic lupus erythematosus. Lupus 2020; 30:342-346. [PMID: 33215560 DOI: 10.1177/0961203320974091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac involvement in systemic lupus erythematosus (SLE) is well documented. The pericardium, myocardium and endocardium, as well as the coronary arteries, the valves and the conduction system can all be affected. While pericarditis is common, arrythmias are less frequently described.We present a 13-year-old male, who had fatigue, anorexia, weight loss, myalgias and arthralgias for four months. On physical examination, we identified bradycardia (heart rate 31-50 bpm), oral and nasal ulcers and polyarthritis. The laboratory results showed hemolytic anemia, hypocomplementemia, antinuclear and anti-dsDNA antibodies, hematuria and non-nephrotic proteinuria. Renal function was normal. Lupus nephritis class II was diagnosed by kidney biopsy. On the transthoracic echocardiogram we identified a minimal pericardial effusion, suggesting pericarditis, and, on the electrocardiogram, we detected sinus arrest with junctional rhythm, denoting sinus node dysfunction. The patient was diagnosed with juvenile SLE with cardiac, renal, musculoskeletal and hematologic involvement. Disease remission and cardiac rhythm control were obtained with steroids and mycophenolate mofetil. Currently, the patient is asymptomatic, with normal sinus rhythm.We described an adolescent with SLE who had sinus node dysfunction upon diagnosis. Other cases have been reported in adults but none in juvenile SLE. All SLE patients should have a thorough cardiac examination to promptly diagnose and treat the innumerous cardiac manifestations of this disease.
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Affiliation(s)
- Miguel Fogaça da Mata
- Pediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Pediatric Nephrology and Kidney Transplantation Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Pediatric Cardiology Division, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Mónica Rebelo
- Pediatric Cardiology Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Helena Sofia Sousa
- Pediatrics Division, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Alexandra Rocha
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Miguel
- Pediatric Nephrology and Kidney Transplantation Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Filipa Oliveira Ramos
- Pediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Patrícia Costa-Reis
- Pediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Pediatric Nephrology and Kidney Transplantation Unit, Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Koca B, Demir T, Kasapçopur Ö. Use of tissue Doppler and its comparison with other pulse Doppler echocardiography in the evaluation of diastolic functions in patients with active juvenile idiopathic arthritis. Clin Rheumatol 2014; 34:1391-6. [PMID: 25146659 DOI: 10.1007/s10067-014-2760-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/24/2014] [Accepted: 08/10/2014] [Indexed: 01/20/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is a systemic chronic inflammatory disease. Cardiac involvement as pericarditis, myocarditis and valvular disease is common in JIA. This study aims to assess left ventricular (LV) diastolic functions with tissue Doppler imaging (TDI) and to compare it with conventional Doppler echocardiography (pulse wave Doppler (PWD)) techniques in patients with active JIA. Forty-five patients with active JIA and 47 healthy age- and sex-matched controls were included in this study. Duration of disease ranged from 6 to 138 months (mean 49.59 ± 31.25 months). In addition to PWD echocardiographic methods, TDI was performed to assess LV functions in all participants. On PWD echocardiography analysis, the JIA group had lower peak E velocity (p < 0.001), higher peak A velocity (p < 0.001) and more prolonged isovolumic relaxation time (IVRT) (p = 0.02). E/A ratio was found to be lower in patients with JIA than that in the control group (p < 0.001). Patients with JIA had a much higher E velocity trace integral (VTI) and A VTI when compared to controls (respectively p = 0.03, p = 0.04). Mitral annular early diastolic velocity (Em), among TDI parameters, was found to be lower in patients with JIA than that in the control group (p < 0.001). Em/Am (mitral annular late diastolic velocity) ratio was found to be lower in JIA patients compared with that in the control group (p < 0.001). There was an increase in IVRT in JIA patients compared to control group (p = 0.04). Though Em VTI was similar in the two groups, patients with JIA had a much higher Am VTI when compared to controls (respectively p = 0.48, p < 0.001). E/Em ratio was higher in patients with JIA than in the control group (p < 0.05). LV diastolic functions were impaired in patients with active JIA, in the absence of clinical evidence of cardiac disease. We have concluded that TDI solo, or jointly with PWD echocardiography, is valuable for the evaluation of diastolic functions in active JIA patients.
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Affiliation(s)
- Bülent Koca
- Department of Paediatric Cardiology, Harran University Medical Faculty, Şanlıurfa, Turkey,
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Seckeler MD, Hoke TR. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol 2011; 3:67-84. [PMID: 21386976 PMCID: PMC3046187 DOI: 10.2147/clep.s12977] [Citation(s) in RCA: 254] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Indexed: 11/23/2022] Open
Abstract
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns around the world. Despite decreasing incidence, there is still a significant disease burden, especially in developing nations. This review provides background on the history of ARF, its pathology and treatment, and the current reported worldwide incidence of ARF and prevalence of RHD.
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Affiliation(s)
- Michael D Seckeler
- Department of Pediatrics, Division of Cardiology, University of Virginia, Charlottesville, VA, USA
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Melina G, Sheppard MN, Pepper JR. Ross operation in a patient with juvenile rheumatoid arthritis. Ann Thorac Surg 2010; 90:e23-4. [PMID: 20667306 DOI: 10.1016/j.athoracsur.2010.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/17/2010] [Accepted: 05/21/2010] [Indexed: 11/18/2022]
Abstract
A 32-year-old woman with juvenile rheumatoid arthritis underwent a redo aortic valve replacement 7 years after a Ross procedure for severe aortic valve regurgitation. Interestingly, the cause of autograft failure was not related to the rheumatoid inflammation process.
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Affiliation(s)
- Giovanni Melina
- Academic Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom
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