Myocardial Involvement in Systemic Lupus Erythematosus: Not only A Problem of Epicardial Coronary Artery

Abstract

42-year-old woman, active smoker, with an history of arterial hypertension and SLE, treated with Prednisone and Hydroxychloroquine, was admitted to the Emergency Department (ED) complaining of severe chest pain. Electrocardiogram revealed normofrequent sinus rhythm with negative/diphasic T waves in Infero-lateral leads. Bedside Transthoracic Echocardiogram (TTE) showed mild impairment of ventricular systolic function (EF 50%) in presence of hypokinesia of the anterior wall in mid- basal segment. Cardiac biomarkers were elevated and a diagnosis of acute coronary syndrome without persistent ST Elevation Myocardial Infarction (ASC N-STEMI) was performed. The patient underwent for coronary angiography that revealed coronary arteries free from significant atherosclerotic lesions. Moreover, Cardiac Magnetic Resonance (CMR) showed signs of hypertrophic cardiomyopathy along with T2 hyperintensity and mesocardial Late Gadolinium Enhancement (LGE) in the basal segment of postero- lateral wall consistent with acute myocarditis.