Copyright 2012. Nova Science Publishers, Inc. All rights reserved.

. May not be reproduced in any form without permission from the publisher, except fair uses permitted under 26 Ana Maria Abreu Velez and Michael S. Howard

Lupus and the Heart and Lungs

The main symptoms and signs of heart or lung involvement are pleuritic pain
(specifically, pain experienced on deep inhalation), shortness of breath, cough and ankle
swelling. In addition, because the drugs used to treat lupus patients suppress the immune
system, chest infections are increased in these patients [76-79]. Pleuritic pain is common in
lupus estimates vary that between 30% and 60% of patients develop this problem during
their clinical course. More severe presentations of lupus may cause pleural effusions;
specifically, these effusions are collections of fluid, often usually starting at the base of the
lungs and occasionally covering a large proportion of the lung surface. Pleural effusion fluid
may constrict the lungs, causing shortness of breath. Pleuritic pain may be confirmed via the
clinical history and examination, and pleural effusions confirmed on a chest x-ray [76-79].
Pleural effusions usually respond rapidly to a short course of steroids. A number of
pathologic conditions may affect the anatomic structure of the lungs themselves, although no
structural alterations are as specific for lupus as interstitial fibrosis. Confirmation of this
abnormality is achieved via chest x-rays and CT (or MRI) scanning. Some lupus patients are
more susceptible to blood clots, which in turn elicit a pulmonary embolus; a pulmonary
embolus may present acutely, or chronically with coughing up of blood [76-79].
Classically, pulmonary embolus pain is at the center front of the chest, and may be
misinterpreted by the patient (or the physician) as a heart attack. Clinical examination, chest
x-rays and an echocardiogram may help to make the distinction [76-79]. A small number of
lupus patients develop heart valvular disease [76-79]. There is a strong association with the
presence of anti-phospholipid antibodies and leaky heart valves; these valve abnormalities
may result in shortness of breath, and should be treated with the assistance of a cardiologist.
Rarely, lupus patients require heart valve surgery. Although the actual number of lupus
patients suffering from myocardial infarctions (MIs) is small, there is an increased risk of
occurrence, especially in women between the ages of thirty five and forty five. The reasons
for this increased risk are not entirely clear; however, some traditional MI risk factors such as
high blood pressure are increased in lupus patients [76-79].
Significantly, anti-phospholipid antibody effects can be minimized by the use of aspirin
or warfarin. Pleuritic pain may often be successfully treated with low to moderate doses of
steroids [76-79]. Increased emphasis is being placed on determining the risk factors for the
development of MIs in lupus patients, including abnormalities in clotting factors and possible
abnormal cholesterol levels. Smoking cessation is also a vital factor in the long-term
management of these problems.

Pregnancy and Contraception for Women

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with Lupus
Although pregnancy in women with lupus is considered high risk, most women with
lupus carry their babies safely to the end of their pregnancy. Some babies have been born
with neonatal lupus [80-84]. Overall, women with lupus have a higher rate of miscarriage and
premature birth relative to the general population. In addition, women who have
antiphospholipid antibodies are at a greater risk of miscarriage in the second trimester

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