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Cardiac wall rupture in systemic lupus erythematosus: a case report and review of the literature

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Abstract

Cardiac wall rupture (CWR) is a serious and often fatal complication of myocardial infarction (MI). Despite an increase in the incidence of MI in patients with systemic lupus erythematosus (SLE), cases of CWR in these patients have been reported rarely. This study reports an SLE patient with CWR and pseudoaneurysm formation and reviews previously reported cases of CWR in SLE patients. An English language literature review of from the PubMed, EMBASE, and Scopus databases on published cases of CWR in SLE, up until January 2023, was performed and analyzed. The search identified 4 patients, including the present one, 5 cases altogether. All of them were female aged 27–40 years, and 3 of them had had SLE for 10 years or more. Chest pain and dyspnea were the common presentations. All had left ventricular (LV) wall rupture. Three patients had LV wall rupture with pseudoaneurysm formation (one had MI with normal coronary artery, one myocardial necrosis secondary from small coronary artery vasculitis and one MI from uncertain cause). The other 2 patients had LV free wall rupture (one had MI with extensive coronary atherosclerosis with coronary arteritis, and the other septic myocarditis with septic coronary arteritis) and these 2 patients died before the diagnosis was made. Three patients with pseudoaneurysm received surgical correction with good clinical outcomes in all. Cardiac wall rupture is a serious and often fatal cardiac complication. Emergency diagnosis and appropriate management with an experienced cardiology team is crucial. Surgical correction is the treatment of choice.

Key Points

• Cardiac wall rupture, a serious and often fatal cardiac complication, has rarely been described in SLE patients.

• Emergency diagnosis and appropriate management with an experienced cardiology team is crucial. Surgical correction is the treatment of choice.

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No new data were created or analyzed in this study. Data sharing is not applicable to this article.

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Acknowledgements

The authors thank Mrs. Waraporn Sukitawut for her secretarial assistance.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Pawut Gumrai & Pannipa Suwannasom

  2. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Kittiya Na-Nan & Worawit Louthrenoo

  3. Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Thitipong Tepsuwan

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  1. Pawut Gumrai
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All of the authors have made substantial contributions to the conception or design, reviewing the articles, interpreting the results, drafting and critically reviewing for intellectual content of this work, and approving the final version of the manuscript for publication. All of the authors also take full responsibility for the integrity and accuracy of all aspects of the work.

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Correspondence to Worawit Louthrenoo.

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This study was approved by the Ethics Committee of the Faculty ofMedicine, Chiang Mai University (no. 0042/2023). It was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Gumrai, P., Na-Nan, K., Tepsuwan, T. et al. Cardiac wall rupture in systemic lupus erythematosus: a case report and review of the literature. Clin Rheumatol 42, 2223–2229 (2023). https://doi.org/10.1007/s10067-023-06614-8

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