Clinical Rheumatology

, Volume 26, Issue 6, pp 965–968 | Cite as

Acute myocardial infarction in systemic sclerosis patients: a case series

  • Chris T. Derk
  • Sergio A. Jimenez
Case Report


To characterize the clinical manifestations of patients with systemic sclerosis who develop a myocardial infarction (MI), a retrospective review of the medical records of all patients who were admitted to our institution between 1982 and 2002 and had the dual diagnosis of systemic sclerosis and an acute MI was done. From 1,009 systemic sclerosis hospital admissions, 11 (1.09%) were for an acute MI. Three of these patients had normal coronaries, and instead of wall motion abnormalities, left ventricular hypertrophy was the predominant finding of an echocardiography. The odds ratio of finding normal coronaries in systemic sclerosis vs the general population who develops an acute MI is 33.89 (14.08–81.39). Seven of our patients had an elevated creatinine level on presentation. Acute MI is an uncommon manifestation in systemic sclerosis patients. Normal coronaries are seen more commonly in these patients as compared to the general population, while vascular, gastrointestinal, and renal involvement is prevalent in these patients.


Acute myocardial infarction Coronary artery disease Raynaud’s phenomenon Systemic sclerosis Tissue fibrosis 



Support was provided by National Institutes of Health grant AR19616 (S.A.J.). Dr. Derk was supported by National Institutes of Health training grant AR07583.


  1. 1.
    Jimenez SA, Derk CT (2004) Following the molecular pathways toward an understanding of the pathogenesis of systemic sclerosis. Ann Intern Med 140:37–50PubMedGoogle Scholar
  2. 2.
    Guiducci S, Pignone A, Matucci-Cerinic M (2004) Raynaud’s phenomenon in systemic sclerosis. In: Clements PJ, Furst DE (eds) Systemic sclerosis. Lippincott, Philadelphia, pp 221–240Google Scholar
  3. 3.
    Eason RJ, Tan PL, Gow PJ (1981) Progressive systemic sclerosis in Auckland: a ten year review with emphasis on prognostic features. Aust N Z J Med 11:657–662PubMedGoogle Scholar
  4. 4.
    Lally EV, Jimenez SA, Kaplan SR (1988) Progressive systemic sclerosis: mode of presentation, rapidly progressive disease course, and mortality based on an analysis of 91 patients. Semin Arthritis Rheum 18:1–13CrossRefPubMedGoogle Scholar
  5. 5.
    Hata N, Kunimi T, Matsuda H et al (1998) Cardiac disorders associated with progressive systemic sclerosis. J Cardiol 32(Suppl):397–402PubMedGoogle Scholar
  6. 6.
    Follansbee WP (1996) Organ involvement: cardiac. In: Clements PJ, Furst DE (eds) Systemic sclerosis. Lippincott, Baltimore, pp 333–364Google Scholar
  7. 7.
    Ammann P, Marschall S, Kraus M et al (2000) Characteristics and prognosis of myocardial infarction in patients with normal coronary arteries. Chest 117(2):333–338CrossRefPubMedGoogle Scholar
  8. 8.
    Sharifi M, Frohlich TG, Silverman IM (1995) Myocardial infarction with angiographically normal coronary arteries. Chest 107(1):36–40PubMedGoogle Scholar
  9. 9.
    Legrand V, Deliege M, Henrard L et al (1982) Patients with myocardial infarction and normal coronary arteriogram. Chest 82(6):678–685PubMedGoogle Scholar
  10. 10.
    Raymond R, Lynch J, Underwood D et al (1988) Myocardial infarction and normal coronary arteriography: a 10 year clinical and risk analysis of 74 patients. J Am Coll Cardiol 11(3):471–477PubMedCrossRefGoogle Scholar
  11. 11.
    Weinberger J, Rotenberg Z, Fuchs J et al (1987) Myocardial infarction in young adults under 30 years: risk factors and clinical course. Clin Cardiol 10(1):9–15PubMedCrossRefGoogle Scholar
  12. 12.
    Medsger TA Jr, Silman AJ, Steen VD et al (1999) A disease severity scale for systemic sclerosis: development and testing. J Rheumatol 26(10):2159–2167PubMedGoogle Scholar
  13. 13.
    Kahan A, Devaux JY, Amor B et al (1986) Nifedipine and thallium-201 myocardial perfusion in progressive systemic sclerosis. N Engl J Med 314:1397–1402PubMedCrossRefGoogle Scholar
  14. 14.
    Alexander EL, Firestein GS, Weiss JL et al (1986) Reversible cold-induced abnormalities in myocardial perfusion and function in systemic sclerosis. Ann Intern Med 105:661–668PubMedGoogle Scholar
  15. 15.
    Follansbee WP, Kiernan JM, Curtiss EI et al (1987) Cold-induced thallium perfusion abnormalities in diffuse scleroderma and Raynaud’s disease: response to diltiazem therapy. Arthritis Rheum 30(Suppl 4):S117Google Scholar
  16. 16.
    Gustafson R, Mannting F, Kazzam E et al (1989) Cold-induced reversible myocardial ischaemia in systemic sclerosis. Lancet 2(8661):475–479CrossRefPubMedGoogle Scholar
  17. 17.
    Bulkley BH, Klacsmann PG, Hutchins GM (1978) Angina pectoris, myocardial infarction and sudden cardiac death with normal coronary arteries: a clinicopathological study of 9 patients with progressive systemic sclerosis. Am Heart J 95:563–569CrossRefPubMedGoogle Scholar
  18. 18.
    Follansbee WP, Miller TR, Curtiss EI et al (1990) A controlled clinicopathologic study of myocardial fibrosis in systemic sclerosis. J Rheumatol 17:656–662PubMedGoogle Scholar
  19. 19.
    D’Angelo WA, Fries JF, Masi AT et al (1969) Pathologic observations in systemic sclerosis: a study of 58 autopsy case and 58 matched controls. Am J Med 46:428–440CrossRefPubMedGoogle Scholar
  20. 20.
    Sackner MA, Akgun N, Kimbel P et al (1964) The pathophysiology of scleroderma involving the heart and respiratory system. Ann Intern Med 60:611–630PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2006

Authors and Affiliations

  1. 1.Division of RheumatologyThomas Jefferson UniversityPhiladelphiaUSA

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