title: Systemic lupus erythematosus presenting with cardiac symptoms.
abstract: BACKGROUND
  The objective of this study was to describe the characteristics of patients presenting to the emergency department with cardiac symptoms subsequently diagnosed to have systemic lupus erythematosus (SLE).
  
  
  METHODS
  The authors performed a review of newly diagnosed SLE patients at 2 hospitals in Tainan city between January 2010 and December 2013. Patients initially presenting with cardiac symptoms were included. Demographic data, presenting symptomatology, laboratory data, and imaging studies were obtained and analyzed.
  
  
  RESULTS
  Eight cases, including 5 female and 3 male patients, were identified during the 4-year study period. The mean age was 37 (range, 15-54) years. Pericardial effusion (63%) and mitral regurgitation (63%) were the most common cardiac abnormalities, followed by impairment of left ventricular systolic function (25%) and tricuspid regurgitation (13%). Most patients showed signs of increased generalized inflammation and immunological activity with elevated levels of C-reactive protein (100%) and anti-dsDNA (88%) and decreased complement levels (63%). The median duration from admission to the diagnosis of SLE was 6.3 (range, 1-13) days, and all patients showed multiple-organ involvement in addition to the cardiovascular system.
  
  
  CONCLUSIONS
  Patients presenting to the emergency department with cardiac symptoms without a history of cardiopulmonary disease or traditional cardiovascular disease risk factors should be assessed for an underlying cause of cardiac decompensation. If the patients exhibit extracardiac manifestations or their illnesses involve multiple-organ systems, screening tests for autoimmune diseases such as SLE are mandatory.
authors.affiliation: Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Ping-Yuan
authors.initials: PY
authors.lastname: Chen
authors.affiliation: Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Ching-Hung
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Tainan University of Technology, Tainan, Taiwan.
authors.forename: Chien-Chin
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Yu-Ying
authors.initials: YY
authors.lastname: Liao
authors.affiliation: Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan; Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: 890502@mail.chimei.org.tw.
authors.forename: Kuo-Tai
authors.initials: KT
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006331:Heart Diseases / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology; D012189:Retrospective Studies; D014262:Tricuspid Valve Insufficiency / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; D002097:C-Reactive Protein