医学
心肌炎
背景(考古学)
心脏病学
内科学
心力衰竭
暴发型
放射科
肌钙蛋白
磁共振成像
重症监护医学
心肌梗塞
生物
古生物学
作者
R. Du Toit,Sumanth Karamchand,Anton Doubell,Helmuth Reuter,Philip Herbst
出处
期刊:Rheumatology
[Oxford University Press]
日期:2022-07-21
卷期号:62 (2): 523-534
被引量:3
标识
DOI:10.1093/rheumatology/keac409
摘要
Abstract Lupus myocarditis (LM) is a potentially fatal manifestation of SLE, occurring in 5–10% of patients. Clinical manifestations may vary from an unexplained tachycardia to fulminant congestive cardiac failure (CCF). With no single clinical or imaging modality being diagnostic, a rational and practical approach to the patient presenting with possible LM is essential. Markers of myocyte injury (including troponin I and creatine kinase) may be unelevated and do not exclude a diagnosis of LM. Findings on ECG are non-specific but remain essential to exclude other causes of CCF such as an acute coronary syndrome or conduction disorders. Echocardiographic modalities including wall motion abnormalities and speckle tracking echocardiography may demonstrate regional and/or global left ventricular dysfunction and is more sensitive than conventional echocardiography, especially early in the course of LM. Cardiac magnetic resonance imaging (CMRI) is regarded as the non-invasive diagnostic modality of choice in myocarditis. While more sensitive and specific than echocardiography, CMRI has certain limitations in the context of SLE, including technical challenges in acutely unwell and uncooperative patients, contraindications to gadolinium use in the context of renal impairment (including lupus nephritis) and limited literature regarding the application of recommended diagnostic CMRI criteria in SLE. Both echocardiography as well as CMRI may detect subclinical myocardial dysfunction and/or injury of which the clinical significance remains uncertain. Considering these challenges, a combined decision-making approach by rheumatologists and cardiologists interpreting diagnostic test results within the clinical context of the patient is essential to ensure an accurate, early diagnosis of LM.
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