Background Systemic lupus erythematosus (SLE) predominantly affects women and increases their cardiovascular disease risk up to three-fold. Young women with SLE face various challenges and gender-specific issues, especially concerning pregnancy. Case Summary A female patient, 37 years old, married with two children, hospitalised for SLE, consulted for chest pain, shortness of breath and dry cough. She quit her medication in the past seven years prior to her admission in the hope of conceiving. Physical exams showed signs of heart failure. ECG revealed recent myocardial infarction (MI). She had increased hs-Troponin T 180.3 pg/mL and NTproBNP 13419 ng/L. An echocardiogram demonstrated a low EF at 30.4%, LV thrombus, and wall motion abnormalities. The angiogram showed severe coronary artery disease. Her condition was then complicated by embolic stroke and recurrent bleeding from anticoagulant subcutaneous punctured sites. Discussion Patients with SLE are prone to hypercoagulability and accelerated atherosclerosis, which may lead to premature mortality. Balancing risk for bleeding vs ischemia is a seesaw decision in this case. The current risk scores do not cater specifically to this population, but the existing ones suggest this patient will have an equally undesired outcome. Hence, a multidisciplinary team discussion was needed. Considering the immense risk of any intervention at the time, the decision was to administer a conservative treatment. Conclusion Recognising and anticipating gender-specific issues in managing patients with SLE are keys to preventing catastrophic complications. Multidisciplinary team involvement is critical in dealing with complex cases.
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