Overview

Cardiac abnormalities contribute significantly to morbidity and mortality in SLE and are among the most important clinical manifestations of the disease. In addition, involvement of the lungs and pleurae is common. Pericarditis, an inflammation of the pericardium, is the most common cardiac abnormality in SLE. Myocarditis, an inflammation of the heart muscle, may also occur, but is rare. Myocardial infarction, caused by atherosclerosis, is increased in SLE patients, even below the age of 35 years.

Pleuritic chest pain is common. Pleurisy is the most common respiratory manifestation in SLE. Attacks of pleuritic pain can also be associated with pleural effusions. Many patients complain of chest pain, but pericardial changes are not often demonstrated on clinical evaluation.

Potential Problems

1. alterations in cardiac function 2. potential for impaired gas exchange and ineffective breathing patterns 3. alteration in tissue perfusion

Potential Cardiopulmonary Manifestations Pericarditis pain in the anterior chest, neck, back, or arms that is often relieved by sitting up shortness of breath swelling of legs and feet audible pericardial friction rub Myocarditis shortness of breath fatigue palpitationss Atherosclerosis Leading to Myocardial Infarction Warning signs of myocardial infarction include: burning, choking, squeezing, or pressing chest pain that may radiate to left shoulder and arm shortness of breath weakness unrelieved indigestion nausea and vomiting Pleurisy shortness of breath chest pain, especially with deep inspiration Leukocytoclastic Vasculitis necrotic ulcerations, including raised hemorrhagic nodules (papule, purpura) that ulcerate, especially on the lower legs, ankles, and dorsa of the feet Valvular Heart Disease (Libman- Sacks Lesions) lesions that may result in cardiac murmurs and valve dysfunction; associated with APLs Venous Thrombosis positive Homans' sign (pain associated with forced dorsiflexion of the ankle) pain, swelling, inflammation, redness, and warmth in the affected limb increased circumference of affected limb Arterial Thrombosis pain or loss of sensation due to ischemia in an extremity paresthesias and loss of position sense coldness pallor paralysis, loss of speech no pulse in the extremity

Nursing Interventions

Objective: Detect changes in cardiac function.

1. Assess the patient for signs and symptoms of potential cardiac problems.

2. Teach the patient signs and symptoms of cardiac problems, including warning signs of a heart attack; reinforce the importance of reporting them to the physician.

3. Educate the patient about medications.

4. Educate the patient about a healthful diet and regular exercise as tolerated.

Objective: Maintain adequate gas exchange and effective breathing patterns.

1. Assess quality and depth of respirations; auscultate breath sounds.

2. Suggest measures to relieve pain, such as relaxation techniques, biofeedback, rest, and pain medications as ordered.

3. Encourage patients who smoke to quit.

Objective: Ensure adequate tissue perfusion.

1. Assess skin color and temperature; check for lesions.

2. Check capillary refill in the nailbeds.

3. Assess for presence of edema and pain in the extremities.

4. Stress the importance of not smoking.

5. Teach the patient the basics of good foot care.

6. Teach the patient to avoid cold temperatures and to keep the hands and feet warm, especially in winter months.

7. Teach the patient the signs and symptoms of vascular impairment that need to be reported to the physician, including a change in skin color or sensation or appearance of lesions.

Objective: Recognize the signs and symptoms of thromboses; refer for immediate medical attention.

1. Teach the patient the signs and symptoms of potential venous or arterial thrombosis and reinforce the need to contact a physician immediately.

Note: For additional information, see the Patient Information Sheet on Serious Conditions Associated With Lupus.



Source: National Institutes of Health, U.S.Dept of Health and Human Services