Abstract
To characterize the clinical manifestations of patients with systemic sclerosis who develop a myocardial infarction (MI), a retrospective review of the medical records of all patients who were admitted to our institution between 1982 and 2002 and had the dual diagnosis of systemic sclerosis and an acute MI was done. From 1,009 systemic sclerosis hospital admissions, 11 (1.09%) were for an acute MI. Three of these patients had normal coronaries, and instead of wall motion abnormalities, left ventricular hypertrophy was the predominant finding of an echocardiography. The odds ratio of finding normal coronaries in systemic sclerosis vs the general population who develops an acute MI is 33.89 (14.08–81.39). Seven of our patients had an elevated creatinine level on presentation. Acute MI is an uncommon manifestation in systemic sclerosis patients. Normal coronaries are seen more commonly in these patients as compared to the general population, while vascular, gastrointestinal, and renal involvement is prevalent in these patients.
References
Jimenez SA, Derk CT (2004) Following the molecular pathways toward an understanding of the pathogenesis of systemic sclerosis. Ann Intern Med 140:37–50
Guiducci S, Pignone A, Matucci-Cerinic M (2004) Raynaud’s phenomenon in systemic sclerosis. In: Clements PJ, Furst DE (eds) Systemic sclerosis. Lippincott, Philadelphia, pp 221–240
Eason RJ, Tan PL, Gow PJ (1981) Progressive systemic sclerosis in Auckland: a ten year review with emphasis on prognostic features. Aust N Z J Med 11:657–662
Lally EV, Jimenez SA, Kaplan SR (1988) Progressive systemic sclerosis: mode of presentation, rapidly progressive disease course, and mortality based on an analysis of 91 patients. Semin Arthritis Rheum 18:1–13
Hata N, Kunimi T, Matsuda H et al (1998) Cardiac disorders associated with progressive systemic sclerosis. J Cardiol 32(Suppl):397–402
Follansbee WP (1996) Organ involvement: cardiac. In: Clements PJ, Furst DE (eds) Systemic sclerosis. Lippincott, Baltimore, pp 333–364
Ammann P, Marschall S, Kraus M et al (2000) Characteristics and prognosis of myocardial infarction in patients with normal coronary arteries. Chest 117(2):333–338
Sharifi M, Frohlich TG, Silverman IM (1995) Myocardial infarction with angiographically normal coronary arteries. Chest 107(1):36–40
Legrand V, Deliege M, Henrard L et al (1982) Patients with myocardial infarction and normal coronary arteriogram. Chest 82(6):678–685
Raymond R, Lynch J, Underwood D et al (1988) Myocardial infarction and normal coronary arteriography: a 10 year clinical and risk analysis of 74 patients. J Am Coll Cardiol 11(3):471–477
Weinberger J, Rotenberg Z, Fuchs J et al (1987) Myocardial infarction in young adults under 30 years: risk factors and clinical course. Clin Cardiol 10(1):9–15
Medsger TA Jr, Silman AJ, Steen VD et al (1999) A disease severity scale for systemic sclerosis: development and testing. J Rheumatol 26(10):2159–2167
Kahan A, Devaux JY, Amor B et al (1986) Nifedipine and thallium-201 myocardial perfusion in progressive systemic sclerosis. N Engl J Med 314:1397–1402
Alexander EL, Firestein GS, Weiss JL et al (1986) Reversible cold-induced abnormalities in myocardial perfusion and function in systemic sclerosis. Ann Intern Med 105:661–668
Follansbee WP, Kiernan JM, Curtiss EI et al (1987) Cold-induced thallium perfusion abnormalities in diffuse scleroderma and Raynaud’s disease: response to diltiazem therapy. Arthritis Rheum 30(Suppl 4):S117
Gustafson R, Mannting F, Kazzam E et al (1989) Cold-induced reversible myocardial ischaemia in systemic sclerosis. Lancet 2(8661):475–479
Bulkley BH, Klacsmann PG, Hutchins GM (1978) Angina pectoris, myocardial infarction and sudden cardiac death with normal coronary arteries: a clinicopathological study of 9 patients with progressive systemic sclerosis. Am Heart J 95:563–569
Follansbee WP, Miller TR, Curtiss EI et al (1990) A controlled clinicopathologic study of myocardial fibrosis in systemic sclerosis. J Rheumatol 17:656–662
D’Angelo WA, Fries JF, Masi AT et al (1969) Pathologic observations in systemic sclerosis: a study of 58 autopsy case and 58 matched controls. Am J Med 46:428–440
Sackner MA, Akgun N, Kimbel P et al (1964) The pathophysiology of scleroderma involving the heart and respiratory system. Ann Intern Med 60:611–630
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Support was provided by National Institutes of Health grant AR19616 (S.A.J.). Dr. Derk was supported by National Institutes of Health training grant AR07583.
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Derk, C.T., Jimenez, S.A. Acute myocardial infarction in systemic sclerosis patients: a case series. Clin Rheumatol 26, 965–968 (2007). https://doi.org/10.1007/s10067-006-0211-8
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DOI: https://doi.org/10.1007/s10067-006-0211-8