title: Combined systolic and diastolic heart failure as the first presentation of mixed connective tissue disease.
abstract: A 50-year-old woman presented with combined systolic and diastolic heart failure and Raynaud's phenomenon with painful necrotic lesions around several nail beds. Several clinical criteria and the specific biochemical findings lead to the diagnosis of mixed connective tissue disease (MCTD) which is an autoimmune connective tissue disease characterized by cutaneous and visceral fibrosis and widespread vascular pathology.After treatment with diuretics, angiotensin-converting enzyme inhibitors (ACE-inhibitor) and beta blockers the heart failure symptoms disappeared and the ejection fraction improved. The severe pain in the hands due to Raynaud's phenomenon diminished only after treatment with calcium channel blocker nifedipine (Adalat, 10 mg, PO, Bayer HealthCare, Germany) without affecting the cardiovascular status. Cardiac involvement in connective tissue disease is not uncommon, but to our knowledge we present here the first case of MCTD with a combined systolic and diastolic heart failure as primary manifestation.
authors.affiliation: AZ Middelheim, Antwerpen, Belgium. Brunoschwagten@hotmail.com
authors.forename: Bruno
authors.initials: B
authors.lastname: Schwagten
authors.forename: Stefan
authors.initials: S
authors.lastname: Verheye
authors.forename: Paul
authors.initials: P
authors.lastname: Van den Heuvel
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D054144:Heart Failure, Diastolic / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D054143:Heart Failure, Systolic / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D008947:Mixed Connective Tissue Disease / Q000150:complications* / Q000188:drug therapy; D009543:Nifedipine / Q000627:therapeutic use; D011928:Raynaud Disease / Q000188:drug therapy / Q000209:etiology; D013318:Stroke Volume / Q000187:drug effects